- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $2,884.03 / $8,511.38
| Facility | | $724.44 | $2,884.03 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $5,248.07 / $7,244.36
| Facility | | $2,818.38 | $5,248.07 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $4,570.88 / $10,000.00
| Facility | | $398.11 | $4,570.88 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $1,174.90 / $2,089.30
| Professional | | $398.11 | $1,174.90 | $2,089.30 |
- 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 |