- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $5,495.41 / $9,772.37
| Facility | | $549.54 | $5,495.41 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $4,466.84 / $6,165.95
| Facility | | $2,089.30 | $4,466.84 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $831.76 / $2,398.83
| Facility | | $660.69 | $831.76 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $562.34 / $1,584.89
| Professional | | $338.84 | $562.34 | $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
- $1,096.48 / $3,467.37 / $7,585.78
| Facility | | $1,096.48 | $3,467.37 | $7,585.78 |