- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $270.26 / $4,771.00 / $9,373.87
| Facility | | $270.26 | $4,771.00 | $9,373.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,525.00 / $11,065.00 / $12,418.00
| Facility | | $8,525.00 | $11,065.00 | $12,418.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $394.44 / $610.00 / $4,571.81
| Facility | | $394.44 | $610.00 | $4,571.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,843.71 / $4,062.44 / $5,078.05
| Professional | | $2,843.71 | $4,062.44 | $5,078.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $260.51 / $3,834.89 / $7,153.97
| Facility | | $260.51 | $3,834.89 | $7,153.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $255.55 / $398.92 / $600.49
| Facility | | $255.55 | $398.92 | $600.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,020.00 / $12,407.00 / $26,244.00
| Facility | | $2,020.00 | $12,407.00 | $26,244.00 |