- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $1,995.26 / $5,888.44
| Facility | | $331.13 | $1,995.26 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $7,762.47 / $10,471.29
| Facility | | $1,479.11 | $7,762.47 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $2,511.89 / $8,317.64
| Facility | | $398.11 | $2,511.89 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $602.56 / $1,023.29
| Professional | | $169.82 | $602.56 | $1,023.29 |
- 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 / $2,818.38 / $5,128.61
| Facility | | $891.25 | $2,818.38 | $5,128.61 |