- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $3,090.30 / $8,511.38
| Facility | | $234.42 | $3,090.30 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $1,412.54 / $2,691.53
| Facility | | $524.81 | $1,412.54 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $398.11 / $588.84
| Facility | | $398.11 | $398.11 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $234.42 / $691.83
| Professional | | $134.90 | $234.42 | $691.83 |
- 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
- $562.34 / $2,818.38 / $7,413.10
| Facility | | $562.34 | $2,818.38 | $7,413.10 |