- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $4,466.84 / $9,772.37
| Facility | | $1,202.26 | $4,466.84 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $12,589.25 / $60,255.96
| Facility | | $9,332.54 | $12,589.25 | $60,255.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $4,570.88 / $14,454.40
| Professional | | $2,884.03 | $4,570.88 | $14,454.40 |
- 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
- $1,862.09 / $5,370.32 / $12,302.69
| Facility | | $1,862.09 | $5,370.32 | $12,302.69 |