- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $3,090.30 / $14,454.40
| Facility | | $331.13 | $3,090.30 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,715.19 / $15,135.61 / $26,302.68
| Facility | | $10,715.19 | $15,135.61 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $16,218.10 / $25,703.96
| Facility | | $13,803.84 | $16,218.10 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $2,818.38 / $8,511.38
| Facility | | $346.74 | $2,818.38 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $6,165.95 / $15,135.61
| Facility | | $371.54 | $6,165.95 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $5,495.41 / $16,218.10
| Professional | | $588.84 | $5,495.41 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $19,054.61 / $27,542.29
| Facility | | $10,000.00 | $19,054.61 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $13,803.84 / $17,782.79
| Facility | | $8,912.51 | $13,803.84 | $17,782.79 |