- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $891.25 / $14,454.40
| Facility | | $426.58 | $891.25 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $7,943.28 / $12,589.25
| Facility | | $5,011.87 | $7,943.28 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,348.96 / $2,238.72
| Facility | | $1,148.15 | $1,348.96 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $891.25 / $10,000.00
| Facility | | $436.52 | $891.25 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $891.25 / $8,317.64
| Facility | | $436.52 | $891.25 | $8,317.64 |
- 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
- $3,235.94 / $6,025.60 / $8,912.51
| Facility | | $3,235.94 | $6,025.60 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $7,413.10 / $9,120.11
| Facility | | $4,897.79 | $7,413.10 | $9,120.11 |