- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.06 / $3,226.00 / $8,294.00
| Facility | | $181.06 | $3,226.00 | $8,294.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.30 / $526.00 / $925.00
| Facility | | $263.30 | $526.00 | $925.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $726.77 / $913.56 / $1,228.63
| Professional | | $726.77 | $913.56 | $1,228.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.21 / $851.65 / $1,566.51
| Facility | | $173.21 | $851.65 | $1,566.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $169.70 / $261.16 / $378.56
| Facility | | $169.70 | $261.16 | $378.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $85.00 / $503.00 / $2,117.00
| Facility | | $85.00 | $503.00 | $2,117.00 |