- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $1,000.00 / $3,162.28
| Facility | | $213.80 | $1,000.00 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $7,762.47 / $12,589.25
| Facility | | $5,011.87 | $7,762.47 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $2,754.23 / $4,466.84
| Facility | | $2,398.83 | $2,754.23 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $870.96 / $3,162.28
| Facility | | $190.55 | $870.96 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $891.25 / $8,128.31
| Facility | | $194.98 | $891.25 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $912.01 / $2,818.38
| Professional | | $302.00 | $912.01 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $6,456.54 / $9,549.93
| Facility | | $6,456.54 | $6,456.54 | $9,549.93 |
- 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 |