- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $2,290.87 / $5,888.44
| Facility | | $346.74 | $2,290.87 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $4,786.30 / $6,606.93
| Facility | | $1,819.70 | $4,786.30 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $588.84 / $3,630.78
| Facility | | $398.11 | $588.84 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $562.34 / $954.99
| Professional | | $208.93 | $562.34 | $954.99 |
- 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
- $891.25 / $2,818.38 / $5,128.61
| Facility | | $891.25 | $2,818.38 | $5,128.61 |