- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $3,311.31 / $7,244.36
| Facility | | $204.17 | $3,311.31 | $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 / $794.33 / $977.24
| Facility | | $426.58 | $794.33 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $147.91 / $302.00
| Professional | | $123.03 | $147.91 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $218.78 / $323.59
| Professional | | $199.53 | $218.78 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $199.53 / $323.59
| Facility | | $141.25 | $199.53 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $190.55 / $691.83
| Facility | | $144.54 | $190.55 | $691.83 |
- 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 |