- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $645.65 / $14,454.40
| Facility | | $398.11 | $645.65 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $18,620.87 / $29,512.09
| Facility | | $13,803.84 | $18,620.87 | $29,512.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $933.25 / $1,513.56
| Facility | | $794.33 | $933.25 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $7,413.10 / $14,454.40
| Facility | | $363.08 | $7,413.10 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $19,498.45 / $34,673.69
| Facility | | $363.08 | $19,498.45 | $34,673.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $724.44 / $1,000.00
| Professional | | $446.68 | $724.44 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97,723.72 / $97,723.72 / $144,543.98
| Facility | | $97,723.72 | $97,723.72 | $144,543.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,125.38 / $22,908.68 / $33,113.11
| Facility | | $14,125.38 | $22,908.68 | $33,113.11 |