- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $6,025.60 / $16,595.87
| Facility | | $537.03 | $6,025.60 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $2,137.96 / $3,981.07
| Facility | | $870.96 | $2,137.96 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $562.34 / $1,412.54
| Facility | | $323.59 | $562.34 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $288.40 / $331.13
| Professional | | $288.40 | $288.40 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $275.42 / $436.52
| Facility | | $190.55 | $275.42 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $6,309.57 / $10,000.00
| Facility | | $616.60 | $6,309.57 | $10,000.00 |