- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $2,089.30 / $5,888.44
| Facility | | $660.69 | $2,089.30 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $4,265.80 / $8,128.31
| Facility | | $3,548.13 | $4,265.80 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,344.23 / $2,344.23
| Facility | | $2,344.23 | $2,344.23 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $645.65 / $1,659.59
| Professional | | $398.11 | $645.65 | $1,659.59 |
- 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
- $1,513.56 / $3,630.78 / $7,079.46
| Facility | | $1,513.56 | $3,630.78 | $7,079.46 |