- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $1,862.09 / $5,888.44
| Facility | | $446.68 | $1,862.09 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $5,011.87 / $6,606.93
| Facility | | $1,905.46 | $5,011.87 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $2,511.89 / $5,370.32
| Facility | | $398.11 | $2,511.89 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $1,096.48 / $1,778.28
| Professional | | $263.03 | $1,096.48 | $1,778.28 |
- 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 |