- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,884.03 / $8,511.38
| Facility | | $1,023.29 | $2,884.03 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $3,981.07 / $11,220.18
| Facility | | $2,754.23 | $3,981.07 | $11,220.18 |
- 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
- $676.08 / $1,202.26 / $2,511.89
| Professional | | $676.08 | $1,202.26 | $2,511.89 |
- 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
- $1,096.48 / $3,548.13 / $6,760.83
| Facility | | $1,096.48 | $3,548.13 | $6,760.83 |