- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $3,548.13 / $8,912.51
| Facility | | $1,202.26 | $3,548.13 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $9,120.11 / $26,302.68
| Facility | | $7,413.10 | $9,120.11 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,041.74 / $5,370.32
| Professional | | $1,258.93 | $2,041.74 | $5,370.32 |
- 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
- $1,445.44 / $6,025.60 / $13,803.84
| Facility | | $1,445.44 | $6,025.60 | $13,803.84 |