- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $5,011.87 / $22,387.21
| Facility | | $630.96 | $5,011.87 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $13,182.57 / $17,782.79
| Facility | | $3,548.13 | $13,182.57 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $12,589.25 / $28,840.32
| Facility | | $9,120.11 | $12,589.25 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $602.56 / $1,584.89
| Professional | | $346.74 | $602.56 | $1,584.89 |
- 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
- $2,570.40 / $9,332.54 / $28,840.32
| Facility | | $2,570.40 | $9,332.54 | $28,840.32 |