- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $488.31 / $5,282.84 / $8,920.00
| Facility | | $488.31 | $5,282.84 | $8,920.00 |
- 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
- $490.00 / $711.69 / $4,635.12
| Facility | | $490.00 | $711.69 | $4,635.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,165.39 / $4,521.99 / $5,652.49
| Professional | | $3,165.39 | $4,521.99 | $5,652.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $471.83 / $4,239.05 / $7,946.81
| Facility | | $471.83 | $4,239.05 | $7,946.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $453.63 / $587.02 / $1,023.84
| Facility | | $453.63 | $587.02 | $1,023.84 |
- 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 |