- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $3,019.95 / $7,244.36
| Facility | | $141.25 | $3,019.95 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,981.07 / $4,466.84
| Facility | | $3,090.30 | $3,981.07 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $1,023.29 / $2,187.76
| Professional | | $107.15 | $1,023.29 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $1,778.28 / $1,778.28
| Professional | | $1,778.28 | $1,778.28 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $645.65 / $1,258.93
| Facility | | $138.04 | $645.65 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.49 / $165.96 / $4,073.80
| Facility | | $117.49 | $165.96 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $3,467.37 / $5,754.40
| Facility | | $1,737.80 | $3,467.37 | $5,754.40 |