- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $1,862.09 / $7,762.47
| Facility | | $588.84 | $1,862.09 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,737.80 / $5,011.87
| Facility | | $1,230.27 | $1,737.80 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $588.84 / $1,096.48
| Facility | | $398.11 | $588.84 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $1,071.52 / $1,819.70
| Professional | | $331.13 | $1,071.52 | $1,819.70 |
- 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
- $891.25 / $2,238.72 / $4,570.88
| Facility | | $891.25 | $2,238.72 | $4,570.88 |