- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $407.38 / $14,454.40
| Facility | | $190.55 | $407.38 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $4,570.88 / $7,079.46
| Facility | | $2,630.27 | $4,570.88 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $602.56 / $1,000.00
| Facility | | $512.86 | $602.56 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $398.11 / $3,548.13
| Facility | | $194.98 | $398.11 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $407.38 / $5,248.07
| Facility | | $199.53 | $407.38 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $446.68 / $676.08
| Professional | | $295.12 | $446.68 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $3,235.94 / $4,786.30
| Facility | | $1,737.80 | $3,235.94 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,801.89 / $6,456.54
| Facility | | $2,884.03 | $3,801.89 | $6,456.54 |