- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $10,964.78 / $10,964.78
| Facility | | $263.03 | $10,964.78 | $10,964.78 |
- 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
- $537.03 / $630.96 / $1,000.00
| Facility | | $537.03 | $630.96 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $7,244.36 / $13,489.63
| Facility | | $263.03 | $7,244.36 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $7,079.46 / $12,302.69
| Facility | | $239.88 | $7,079.46 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $501.19 / $891.25
| Professional | | $354.81 | $501.19 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $10,964.78 / $10,964.78
| Facility | | $7,585.78 | $10,964.78 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $10,232.93 / $13,182.57
| Facility | | $6,606.93 | $10,232.93 | $13,182.57 |