- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $3,715.35 / $8,912.51
| Facility | | $1,047.13 | $3,715.35 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $8,912.51 / $22,908.68
| Facility | | $7,413.10 | $8,912.51 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $7,585.78 / $7,585.78
| Facility | | $7,585.78 | $7,585.78 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $2,511.89 / $5,495.41
| Professional | | $933.25 | $2,511.89 | $5,495.41 |
- 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 |