- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $4,897.79 / $9,772.37
| Facility | | $234.42 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $1,318.26 / $2,511.89
| Facility | | $562.34 | $1,318.26 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $426.58 / $1,318.26
| Facility | | $144.54 | $426.58 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $426.58 / $436.52
| Professional | | $426.58 | $426.58 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $93.33 / $288.40 / $1,380.38
| Facility | | $93.33 | $288.40 | $1,380.38 |
- 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 |