- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $4,168.69 / $9,772.37
| Facility | | $1,122.02 | $4,168.69 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $3,235.94 / $11,481.54
| Professional | | $1,023.29 | $3,235.94 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $457.09 / $549.54
| Facility | | $407.38 | $457.09 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $199.53 / $346.74
| Professional | | $100.00 | $199.53 | $346.74 |
- 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
- $154.88 / $758.58 / $2,187.76
| Facility | | $154.88 | $758.58 | $2,187.76 |