- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $553.82 / $3,645.00 / $8,294.00
| Facility | | $553.82 | $3,645.00 | $8,294.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,060.00 / $3,693.00 / $4,290.00
| Facility | | $3,060.00 | $3,693.00 | $4,290.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $553.94 / $553.94 / $572.00
| Facility | | $553.94 | $553.94 | $572.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $474.00 / $606.72 / $706.93
| Professional | | $474.00 | $606.72 | $706.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $499.04 / $643.30 / $943.58
| Facility | | $499.04 | $643.30 | $943.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $477.78 / $631.84 / $2,132.69
| Facility | | $477.78 | $631.84 | $2,132.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,651.00 / $6,870.00 / $12,739.00
| Facility | | $3,651.00 | $6,870.00 | $12,739.00 |