- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $4,786.30 / $9,120.11
| Facility | | $223.87 | $4,786.30 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $354.81 / $602.56
| Professional | | $239.88 | $354.81 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $302.00 / $446.68
| Professional | | $223.87 | $302.00 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $15,848.93 / $16,982.44
| Facility | | $6,456.54 | $15,848.93 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,000.00
| Facility | | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $281.84 / $446.68
| Professional | | $234.42 | $281.84 | $446.68 |