- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $912.01 / $14,454.40
| Facility | | $426.58 | $912.01 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $8,317.64 / $13,182.57
| Facility | | $5,011.87 | $8,317.64 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,348.96 / $2,137.96
| Facility | | $1,148.15 | $1,348.96 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $870.96 / $6,456.54
| Facility | | $436.52 | $870.96 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $912.01 / $11,220.18
| Facility | | $446.68 | $912.01 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $1,000.00 / $1,513.56
| Professional | | $660.69 | $1,000.00 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $8,912.51 / $8,912.51
| Facility | | $6,025.60 | $8,912.51 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $10,232.93 / $12,589.25
| Facility | | $6,606.93 | $10,232.93 | $12,589.25 |