- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $1,862.09 / $8,511.38
| Facility | | $346.74 | $1,862.09 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $4,570.88 / $8,709.64
| Facility | | $1,698.24 | $4,570.88 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $15,135.61 / $19,498.45
| Facility | | $4,677.35 | $15,135.61 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $575.44 / $2,511.89
| Professional | | $363.08 | $575.44 | $2,511.89 |
- 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
- $1,778.28 / $6,918.31 / $14,454.40
| Facility | | $1,778.28 | $6,918.31 | $14,454.40 |