- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $1,862.09 / $7,762.47
| Facility | | $257.04 | $1,862.09 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $1,023.29 / $1,949.84
| Facility | | $870.96 | $1,023.29 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $741.31 / $741.31
| Facility | | $741.31 | $741.31 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $363.08 / $1,096.48
| Professional | | $125.89 | $363.08 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $1,479.11 / $3,715.35
| Facility | | $588.84 | $1,479.11 | $3,715.35 |