- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $2,570.40 / $8,511.38
| Facility | | $724.44 | $2,570.40 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $5,495.41 / $7,943.28
| Facility | | $2,818.38 | $5,495.41 | $7,943.28 |
- 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
- $457.09 / $1,348.96 / $2,398.83
| Professional | | $457.09 | $1,348.96 | $2,398.83 |
- 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 |