- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $3,467.37 / $7,244.36
| Facility | | $281.84 | $3,467.37 | $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
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $870.96 / $1,148.15
| Facility | | $426.58 | $870.96 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $776.25 / $1,318.26
| Professional | | $446.68 | $776.25 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $295.12 / $575.44
| Professional | | $275.42 | $295.12 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $346.74 / $1,000.00
| Facility | | $177.83 | $346.74 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.96 / $234.42 / $794.33
| Facility | | $165.96 | $234.42 | $794.33 |
- 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 |