- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $4,897.79 / $16,595.87
| Facility | | $281.84 | $4,897.79 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $1,348.96 / $3,548.13
| Facility | | $588.84 | $1,348.96 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $426.58 / $1,318.26
| Facility | | $173.78 | $426.58 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $389.05 / $398.11
| Professional | | $389.05 | $389.05 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.49 / $263.03 / $501.19
| Facility | | $117.49 | $263.03 | $501.19 |
- 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 |