- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $6,025.60 / $16,595.87
| Facility | | $245.47 | $6,025.60 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $3,548.13 / $6,760.83
| Facility | | $1,778.28 | $3,548.13 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $501.19 / $1,148.15
| Facility | | $162.18 | $501.19 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $281.84 / $524.81
| Professional | | $281.84 | $281.84 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $208.93 / $398.11
| Facility | | $100.00 | $208.93 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $6,760.83 / $10,000.00
| Facility | | $1,479.11 | $6,760.83 | $10,000.00 |