- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $7,244.36 / $16,595.87
| Facility | | $302.00 | $7,244.36 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $2,570.40 / $4,897.79
| Facility | | $1,096.48 | $2,570.40 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $371.54 / $1,148.15
| Facility | | $34.67 | $371.54 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $141.25 / $162.18
| Professional | | $141.25 | $141.25 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.15 / $144.54 / $234.42
| Facility | | $107.15 | $144.54 | $234.42 |
- 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 |