- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.20 / $112.20 / $8,709.64
| Facility | | $91.20 | $112.20 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $4,897.79 / $7,585.78
| Facility | | $3,311.31 | $4,897.79 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $288.40 / $457.09
| Facility | | $245.47 | $288.40 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $87.10 / $2,089.30 / $4,786.30
| Facility | | $87.10 | $2,089.30 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $87.10 / $5,128.61 / $8,317.64
| Facility | | $87.10 | $5,128.61 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $218.78 / $371.54
| Professional | | $112.20 | $218.78 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $5,495.41 / $5,495.41
| Facility | | $3,715.35 | $5,495.41 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $7,413.10 / $9,120.11
| Facility | | $4,897.79 | $7,413.10 | $9,120.11 |