- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $6,760.83 / $16,595.87
| Facility | | $562.34 | $6,760.83 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,778.28 / $3,162.28
| Facility | | $1,000.00 | $1,778.28 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $446.68 / $575.44
| Facility | | $446.68 | $446.68 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $645.65 / $645.65
| Professional | | $645.65 | $645.65 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $467.74 / $676.08
| Facility | | $316.23 | $467.74 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $1,230.27 / $3,548.13
| Facility | | $380.19 | $1,230.27 | $3,548.13 |