- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $3,548.13 / $11,481.54
| Facility | | $954.99 | $3,548.13 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,848.93 / $18,620.87 / $34,673.69
| Facility | | $15,848.93 | $18,620.87 | $34,673.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,630.27 / $7,413.10
| Professional | | $1,659.59 | $2,630.27 | $7,413.10 |
- 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
- $1,288.25 / $6,309.57 / $16,982.44
| Facility | | $1,288.25 | $6,309.57 | $16,982.44 |