- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $3,548.13 / $8,912.51
| Facility | | $977.24 | $3,548.13 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $3,981.07 / $9,120.11
| Facility | | $2,238.72 | $3,981.07 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $724.44 / $2,691.53
| Facility | | $575.44 | $724.44 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $977.24 / $2,290.87
| Professional | | $575.44 | $977.24 | $2,290.87 |
- 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 / $6,760.83
| Facility | | $1,096.48 | $3,467.37 | $6,760.83 |