- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $6,025.60 / $16,595.87
| Facility | | $457.09 | $6,025.60 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $1,380.38 / $3,388.44
| Facility | | $741.31 | $1,380.38 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $575.44 / $1,412.54
| Facility | | $275.42 | $575.44 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $295.12 / $338.84
| Professional | | $295.12 | $295.12 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $331.13 / $1,047.13
| Facility | | $181.97 | $331.13 | $1,047.13 |
- 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 |