- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $2,089.30 / $5,888.44
| Facility | | $446.68 | $2,089.30 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $8,912.51 / $12,022.64
| Facility | | $2,570.40 | $8,912.51 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $7,762.47 / $10,964.78
| Facility | | $6,309.57 | $7,762.47 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $371.54 / $1,174.90
| Professional | | $239.88 | $371.54 | $1,174.90 |
- 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
- $1,698.24 / $5,623.41 / $9,772.37
| Facility | | $1,698.24 | $5,623.41 | $9,772.37 |