- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $1,995.26 / $6,309.57
| Facility | | $275.42 | $1,995.26 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $1,621.81 / $2,089.30
| Facility | | $933.25 | $1,621.81 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,698.24 / $2,754.23
| Facility | | $302.00 | $1,698.24 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $416.87 / $954.99
| Professional | | $141.25 | $416.87 | $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
- $831.76 / $2,238.72 / $4,570.88
| Facility | | $831.76 | $2,238.72 | $4,570.88 |