- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $3,090.30 / $8,511.38
| Facility | | $512.86 | $3,090.30 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $3,311.31 / $6,456.54
| Facility | | $1,230.27 | $3,311.31 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $398.11 / $588.84
| Facility | | $398.11 | $398.11 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $501.19 / $1,584.89
| Professional | | $288.40 | $501.19 | $1,584.89 |
- 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
- $562.34 / $2,818.38 / $7,413.10
| Facility | | $562.34 | $2,818.38 | $7,413.10 |