- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $1,862.09 / $8,511.38
| Facility | | $257.04 | $1,862.09 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $2,454.71 / $3,311.31
| Facility | | $1,148.15 | $2,454.71 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,698.24 / $2,754.23
| Facility | | $302.00 | $1,698.24 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $1,047.13 / $1,412.54
| Professional | | $158.49 | $1,047.13 | $1,412.54 |
- 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
- $831.76 / $2,238.72 / $4,786.30
| Facility | | $831.76 | $2,238.72 | $4,786.30 |