- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $3,235.94 / $10,000.00
| Facility | | $181.97 | $3,235.94 | $10,000.00 |
- 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
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $616.60 / $1,148.15
| Facility | | $489.78 | $616.60 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $158.49 / $323.59
| Professional | | $131.83 | $158.49 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $354.81 / $354.81
| Professional | | $223.87 | $354.81 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.91 / $190.55 / $309.03
| Facility | | $147.91 | $190.55 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $177.83 / $741.31
| Facility | | $138.04 | $177.83 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $2,884.03 / $5,754.40
| Facility | | $512.86 | $2,884.03 | $5,754.40 |