- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $4,897.79 / $16,595.87
| Facility | | $616.60 | $4,897.79 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $1,548.82 / $3,162.28
| Facility | | $660.69 | $1,548.82 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $676.08 / $812.83
| Facility | | $371.54 | $676.08 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $630.96 / $741.31
| Professional | | $630.96 | $630.96 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $602.56 / $1,000.00
| Facility | | $416.87 | $602.56 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $6,309.57 / $10,000.00
| Facility | | $616.60 | $6,309.57 | $10,000.00 |