- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $1,995.26 / $7,762.47
| Facility | | $257.04 | $1,995.26 | $7,762.47 |
- 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 / $1,288.25
| Facility | | $398.11 | $398.11 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $380.19 / $691.83
| Professional | | $134.90 | $380.19 | $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
- $812.83 / $2,398.83 / $4,786.30
| Facility | | $812.83 | $2,398.83 | $4,786.30 |