- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.57 / $15,488.17 / $15,488.17
| Facility | | $64.57 | $15,488.17 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $4,786.30 / $7,585.78
| Facility | | $3,311.31 | $4,786.30 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $190.55 / $302.00
| Facility | | $162.18 | $190.55 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $69.18 / $2,884.03 / $5,370.32
| Facility | | $69.18 | $2,884.03 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $69.18 / $3,235.94 / $6,309.57
| Facility | | $69.18 | $3,235.94 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $141.25 / $239.88
| Professional | | $72.44 | $141.25 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $9,332.54 / $9,332.54
| Facility | | $6,309.57 | $9,332.54 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,801.89 / $6,606.93
| Facility | | $2,884.03 | $3,801.89 | $6,606.93 |