- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $1,000.00 / $14,454.40
| Facility | | $436.52 | $1,000.00 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $12,882.50 / $22,387.21
| Facility | | $9,120.11 | $12,882.50 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,479.11 / $2,344.23
| Facility | | $1,258.93 | $1,479.11 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $6,760.83 / $13,489.63
| Facility | | $489.78 | $6,760.83 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $2,691.53 / $7,943.28
| Facility | | $489.78 | $2,691.53 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $1,230.27 / $2,089.30
| Professional | | $645.65 | $1,230.27 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $5,128.61 / $5,128.61
| Facility | | $1,258.93 | $5,128.61 | $5,128.61 |
- 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 |