- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $3,981.07 / $8,511.38
| Facility | | $389.05 | $3,981.07 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $4,897.79 / $7,585.78
| Facility | | $3,311.31 | $4,897.79 | $7,585.78 |
- 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
- $288.40 / $416.87 / $5,623.41
| Facility | | $288.40 | $416.87 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $467.74 / $7,762.47
| Facility | | $302.00 | $467.74 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $645.65 / $1,000.00
| Professional | | $354.81 | $645.65 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $7,943.28 / $7,943.28
| Facility | | $5,370.32 | $7,943.28 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $7,413.10 / $9,120.11
| Facility | | $4,897.79 | $7,413.10 | $9,120.11 |