- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $4,466.84 / $9,772.37
| Facility | | $524.81 | $4,466.84 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $3,162.28 / $6,309.57
| Facility | | $1,122.02 | $3,162.28 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $371.54 / $1,380.38
| Facility | | $331.13 | $371.54 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $323.59 / $457.09
| Professional | | $323.59 | $323.59 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $263.03 / $489.78
| Facility | | $190.55 | $263.03 | $489.78 |
- 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 |