- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $2,630.27 / $9,772.37
| Facility | | $537.03 | $2,630.27 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $6,456.54 / $8,511.38
| Facility | | $3,235.94 | $6,456.54 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $7,413.10 / $8,128.31
| Facility | | $4,365.16 | $7,413.10 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $478.63 / $2,398.83
| Professional | | $309.03 | $478.63 | $2,398.83 |
- 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
- $1,288.25 / $4,073.80 / $7,585.78
| Facility | | $1,288.25 | $4,073.80 | $7,585.78 |