- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $2,344.23 / $8,511.38
| Facility | | $588.84 | $2,344.23 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $4,365.16 / $9,332.54
| Facility | | $3,548.13 | $4,365.16 | $9,332.54 |
- 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
- $446.68 / $776.25 / $1,737.80
| Professional | | $446.68 | $776.25 | $1,737.80 |
- 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
- $1,412.54 / $3,548.13 / $6,918.31
| Facility | | $1,412.54 | $3,548.13 | $6,918.31 |