- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $2,187.76 / $8,511.38
| Facility | | $851.14 | $2,187.76 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $3,981.07 / $14,125.38
| Facility | | $2,818.38 | $3,981.07 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,548.82 / $2,398.83
| Facility | | $1,230.27 | $1,548.82 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $2,238.72 / $3,801.89
| Professional | | $891.25 | $2,238.72 | $3,801.89 |
- 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
- $1,412.54 / $4,365.16 / $8,912.51
| Facility | | $1,412.54 | $4,365.16 | $8,912.51 |