- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $4,168.69 / $11,481.54
| Facility | | $1,258.93 | $4,168.69 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,620.87 / $25,118.86 / $38,018.94
| Facility | | $18,620.87 | $25,118.86 | $38,018.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.70 / $3,162.28 / $8,912.51
| Professional | | $1,819.70 | $3,162.28 | $8,912.51 |
- 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
- $1,949.84 / $8,128.31 / $28,840.32
| Facility | | $1,949.84 | $8,128.31 | $28,840.32 |