- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $1,288.25 / $14,791.08
| Facility | | $478.63 | $1,288.25 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $4,786.30 / $7,585.78
| Facility | | $3,311.31 | $4,786.30 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,584.89 / $2,511.89
| Facility | | $1,348.96 | $1,584.89 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $851.14 / $3,548.13
| Facility | | $478.63 | $851.14 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $1,000.00 / $8,128.31
| Facility | | $478.63 | $1,000.00 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,174.90 / $1,778.28
| Professional | | $776.25 | $1,174.90 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $5,248.07 / $5,248.07
| Facility | | $3,548.13 | $5,248.07 | $5,248.07 |
- 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 |