- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $4,897.79 / $16,595.87
| Facility | | $316.23 | $4,897.79 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $3,162.28 / $6,456.54
| Facility | | $691.83 | $3,162.28 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $371.54 / $616.60
| Facility | | $34.67 | $371.54 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $173.78 / $204.17
| Professional | | $173.78 | $173.78 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.49 / $162.18 / $257.04
| Facility | | $117.49 | $162.18 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $6,165.95 / $10,000.00
| Facility | | $588.84 | $6,165.95 | $10,000.00 |