- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $340.07 / $853.88 / $1,894.00
| Facility | | $340.07 | $853.88 | $1,894.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,183.00 / $9,096.00 / $15,579.70
| Facility | | $1,183.00 | $9,096.00 | $15,579.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,075.04 / $1,256.26 / $2,026.31
| Facility | | $1,075.04 | $1,256.26 | $2,026.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $340.07 / $455.40 / $815.93
| Facility | | $340.07 | $455.40 | $815.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $340.07 / $670.43 / $6,150.00
| Facility | | $340.07 | $670.43 | $6,150.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $337.10 / $455.40 / $815.93
| Facility | | $337.10 | $455.40 | $815.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $745.25 / $1,066.89 / $1,476.69
| Professional | | $745.25 | $1,066.89 | $1,476.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,139.84 / $3,139.84 / $3,139.84
| Facility | | $3,139.84 | $3,139.84 | $3,139.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,976.00 / $4,155.00 / $5,865.00
| Facility | | $2,976.00 | $4,155.00 | $5,865.00 |