- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $573.15 / $5,087.00 / $8,294.00
| Facility | | $573.15 | $5,087.00 | $8,294.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,032.00 / $6,548.00 / $7,221.00
| Facility | | $5,032.00 | $6,548.00 | $7,221.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $590.71 / $590.71 / $640.00
| Facility | | $590.71 | $590.71 | $640.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $499.85 / $641.60 / $758.25
| Professional | | $499.85 | $641.60 | $758.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $527.95 / $673.84 / $998.29
| Facility | | $527.95 | $673.84 | $998.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $498.72 / $648.15 / $2,230.00
| Facility | | $498.72 | $648.15 | $2,230.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,121.00 / $9,270.00 / $17,192.00
| Facility | | $5,121.00 | $9,270.00 | $17,192.00 |