- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $3,388.44 / $9,549.93
| Facility | | $1,023.29 | $3,388.44 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $11,220.18 / $34,673.69
| Facility | | $9,332.54 | $11,220.18 | $34,673.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,630.27 / $10,964.78
| Professional | | $1,659.59 | $2,630.27 | $10,964.78 |
- 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
- $1,778.28 / $7,244.36 / $16,982.44
| Facility | | $1,778.28 | $7,244.36 | $16,982.44 |