- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $424.72 / $3,675.51 / $13,893.24
| Facility | | $424.72 | $3,675.51 | $13,893.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,032.00 / $6,548.00 / $7,221.00
| Facility | | $5,032.00 | $6,548.00 | $7,221.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.00 / $621.05 / $1,896.02
| Facility | | $490.00 | $621.05 | $1,896.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $971.46 / $1,406.53 / $1,734.75
| Professional | | $971.46 | $1,406.53 | $1,734.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $410.44 / $1,342.93 / $2,473.73
| Facility | | $410.44 | $1,342.93 | $2,473.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $402.55 / $526.17 / $895.26
| Facility | | $402.55 | $526.17 | $895.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,236.00 / $8,246.00 / $17,187.00
| Facility | | $1,236.00 | $8,246.00 | $17,187.00 |