- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $3,801.89 / $9,772.37
| Facility | | $537.03 | $3,801.89 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $407.38 / $691.83
| Facility | | $213.80 | $407.38 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $575.44 / $724.44
| Facility | | $371.54 | $575.44 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $707.95 / $1,071.52
| Professional | | $707.95 | $707.95 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $575.44 / $1,000.00
| Facility | | $416.87 | $575.44 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $1,230.27 / $4,677.35
| Facility | | $354.81 | $1,230.27 | $4,677.35 |