- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $3,311.31 / $9,549.93
| Facility | | $645.65 | $3,311.31 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $3,981.07 / $6,918.31
| Facility | | $2,041.74 | $3,981.07 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $588.84 / $2,691.53
| Facility | | $446.68 | $588.84 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $831.76 / $1,819.70
| Professional | | $436.52 | $831.76 | $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
- $1,096.48 / $3,467.37 / $6,760.83
| Facility | | $1,096.48 | $3,467.37 | $6,760.83 |