- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $676.08 / $6,456.54
| Facility | | $316.23 | $676.08 | $6,456.54 |
- 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
- $1,258.93 / $1,479.11 / $2,344.23
| Facility | | $1,258.93 | $1,479.11 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $645.65 / $4,677.35
| Facility | | $354.81 | $645.65 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $676.08 / $7,762.47
| Facility | | $354.81 | $676.08 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $1,000.00 / $1,548.82
| Professional | | $588.84 | $1,000.00 | $1,548.82 |
- 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
- $4,897.79 / $7,413.10 / $9,120.11
| Facility | | $4,897.79 | $7,413.10 | $9,120.11 |