- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $3,311.31 / $9,772.37
| Facility | | $724.44 | $3,311.31 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $5,128.61 / $10,232.93
| Facility | | $2,511.89 | $5,128.61 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $5,754.40 / $10,964.78
| Facility | | $660.69 | $5,754.40 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $1,096.48 / $2,630.27
| Professional | | $616.60 | $1,096.48 | $2,630.27 |
- 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
- $1,584.89 / $4,365.16 / $9,332.54
| Facility | | $1,584.89 | $4,365.16 | $9,332.54 |