- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $1,862.09 / $5,888.44
| Facility | | $239.88 | $1,862.09 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $3,630.78 / $5,623.41
| Facility | | $1,380.38 | $3,630.78 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $1,288.25 / $2,691.53
| Facility | | $398.11 | $1,288.25 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $363.08 / $851.14
| Professional | | $181.97 | $363.08 | $851.14 |
- 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
- $1,096.48 / $3,467.37 / $7,585.78
| Facility | | $1,096.48 | $3,467.37 | $7,585.78 |