- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $676.08 / $14,454.40
| Facility | | $426.58 | $676.08 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $18,197.01 / $30,199.52
| Facility | | $12,882.50 | $18,197.01 | $30,199.52 |
- 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
- $380.19 / $7,762.47 / $14,454.40
| Facility | | $380.19 | $7,762.47 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $3,388.44 / $9,549.93
| Facility | | $380.19 | $3,388.44 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $794.33 / $1,096.48
| Professional | | $489.78 | $794.33 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $2,344.23
| Facility | | $851.14 | $851.14 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $6,165.95 / $19,498.45
| Facility | | $2,290.87 | $6,165.95 | $19,498.45 |