- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $3,630.78 / $9,549.93
| Facility | | $251.19 | $3,630.78 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $5,248.07 / $7,079.46
| Facility | | $3,467.37 | $5,248.07 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $208.93 / $257.04
| Professional | | $173.78 | $208.93 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $549.54 / $676.08
| Professional | | $467.74 | $549.54 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $426.58 / $676.08
| Facility | | $199.53 | $426.58 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $446.68 / $10,000.00
| Facility | | $213.80 | $446.68 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,467.37 / $7,079.46
| Facility | | $1,698.24 | $3,467.37 | $7,079.46 |