- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $3,630.78 / $8,317.64
| Facility | | $229.09 | $3,630.78 | $8,317.64 |
- 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
- $173.78 / $208.93 / $524.81
| Professional | | $173.78 | $208.93 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $457.09 / $457.09
| Professional | | $457.09 | $457.09 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $275.42 / $416.87
| Facility | | $194.98 | $275.42 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $288.40 / $10,000.00
| Facility | | $186.21 | $288.40 | $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 |