- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $5,495.41 / $9,772.37
| Facility | | $630.96 | $5,495.41 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $4,265.80 / $5,754.40
| Facility | | $2,089.30 | $4,265.80 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $724.44 / $2,691.53
| Facility | | $575.44 | $724.44 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $467.74 / $1,380.38
| Professional | | $281.84 | $467.74 | $1,380.38 |
- 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
- $1,023.29 / $3,467.37 / $7,585.78
| Facility | | $1,023.29 | $3,467.37 | $7,585.78 |