- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $4,677.35 / $9,772.37
| Facility | | $416.87 | $4,677.35 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $1,905.46 / $3,630.78
| Facility | | $691.83 | $1,905.46 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $562.34 / $1,096.48
| Facility | | $245.47 | $562.34 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $1,584.89 / $1,659.59
| Professional | | $1,584.89 | $1,584.89 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $741.31 / $1,698.24
| Facility | | $162.18 | $741.31 | $1,698.24 |
- 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 |