- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $3,090.30 / $12,022.64
| Facility | | $295.12 | $3,090.30 | $12,022.64 |
- 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
- $602.56 / $707.95 / $1,122.02
| Facility | | $602.56 | $707.95 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $3,090.30 / $5,370.32
| Facility | | $295.12 | $3,090.30 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $7,079.46 / $12,302.69
| Facility | | $269.15 | $7,079.46 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $575.44 / $1,000.00
| Professional | | $407.38 | $575.44 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $8,912.51 / $8,912.51
| Facility | | $6,165.95 | $8,912.51 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $10,232.93 / $12,589.25
| Facility | | $6,606.93 | $10,232.93 | $12,589.25 |