- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $93.33 / $4,897.79 / $9,772.37
| Facility | | $93.33 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $1,548.82 / $2,951.21
| Facility | | $660.69 | $1,548.82 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $575.44 / $1,000.00
| Facility | | $134.90 | $575.44 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $144.54 / $302.00
| Professional | | $144.54 | $144.54 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $69.18 / $123.03 / $245.47
| Facility | | $69.18 | $123.03 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $3,890.45 / $7,762.47
| Facility | | $1,096.48 | $3,890.45 | $7,762.47 |