- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.03 / $1,862.09 / $5,011.87
| Facility | | $123.03 | $1,862.09 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $5,248.07 / $7,244.36
| Facility | | $3,890.45 | $5,248.07 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $660.69 / $660.69
| Facility | | $660.69 | $660.69 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $141.25 / $776.25
| Professional | | $61.66 | $141.25 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $676.08 / $676.08
| Facility | | $676.08 | $676.08 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $1,584.89 / $10,000.00
| Facility | | $407.38 | $1,584.89 | $10,000.00 |