- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.82 / $1,905.46 / $3,981.07
| Facility | | $114.82 | $1,905.46 | $3,981.07 |
- 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
- $234.42 / $275.42 / $436.52
| Facility | | $234.42 | $275.42 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $2,454.71 / $4,786.30
| Facility | | $100.00 | $2,454.71 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $2,398.83 / $4,466.84
| Facility | | $100.00 | $2,398.83 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $223.87 / $371.54
| Professional | | $138.04 | $223.87 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,548.13 / $3,548.13
| Facility | | $2,454.71 | $3,548.13 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,884.03 / $5,011.87
| Facility | | $2,344.23 | $2,884.03 | $5,011.87 |