- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $414.85 / $4,306.45 / $9,520.24
| Facility | | $414.85 | $4,306.45 | $9,520.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,823.00 / $12,004.00 / $15,528.00
| Facility | | $9,823.00 | $12,004.00 | $15,528.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $623.69 / $623.69 / $640.00
| Facility | | $623.69 | $623.69 | $640.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,242.72 / $4,196.46 / $4,959.45
| Professional | | $3,242.72 | $4,196.46 | $4,959.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $414.85 / $3,322.88 / $6,884.80
| Facility | | $414.85 | $3,322.88 | $6,884.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $359.82 / $507.32 / $4,602.78
| Facility | | $359.82 | $507.32 | $4,602.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,423.00 / $11,475.00 / $21,639.00
| Facility | | $6,423.00 | $11,475.00 | $21,639.00 |