- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $4,073.80 / $9,772.37
| Facility | | $1,023.29 | $4,073.80 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $5,011.87 / $12,589.25
| Facility | | $4,168.69 | $5,011.87 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $2,691.53 / $2,691.53
| Facility | | $2,691.53 | $2,691.53 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $954.99 / $3,311.31
| Professional | | $588.84 | $954.99 | $3,311.31 |
- 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
- $2,137.96 / $5,370.32 / $12,302.69
| Facility | | $2,137.96 | $5,370.32 | $12,302.69 |