- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $3,019.95 / $7,244.36
| Facility | | $363.08 | $3,019.95 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $6,760.83 / $7,413.10
| Facility | | $5,888.44 | $6,760.83 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $269.15 / $676.08
| Professional | | $218.78 | $269.15 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $467.74 / $588.84
| Professional | | $371.54 | $467.74 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $363.08 / $575.44
| Facility | | $251.19 | $363.08 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $346.74 / $10,000.00
| Facility | | $239.88 | $346.74 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $9,549.93 / $19,054.61
| Facility | | $5,623.41 | $9,549.93 | $19,054.61 |