- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $5,011.87 / $8,317.64
| Facility | | $363.08 | $5,011.87 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $7,413.10 / $9,332.54
| Facility | | $6,606.93 | $7,413.10 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $380.19 / $954.99
| Professional | | $302.00 | $380.19 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $501.19 / $812.83
| Professional | | $398.11 | $501.19 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $446.68 / $660.69
| Facility | | $309.03 | $446.68 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $436.52 / $10,000.00
| Facility | | $281.84 | $436.52 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $11,481.54 / $23,988.33
| Facility | | $6,760.83 | $11,481.54 | $23,988.33 |