- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $676.08 / $14,454.40
| Facility | | $416.87 | $676.08 | $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
- $851.14 / $1,000.00 / $1,584.89
| Facility | | $851.14 | $1,000.00 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $7,413.10 / $14,454.40
| Facility | | $389.05 | $7,413.10 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $9,332.54 / $75,857.76
| Facility | | $380.19 | $9,332.54 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $794.33 / $1,412.54
| Professional | | $562.34 | $794.33 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $6,760.83 / $10,232.93
| Facility | | $6,760.83 | $6,760.83 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $11,220.18 / $83,176.38
| Facility | | $6,606.93 | $11,220.18 | $83,176.38 |