- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $2,884.03 / $9,332.54
| Facility | | $1,202.26 | $2,884.03 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $5,011.87 / $32,359.37
| Facility | | $3,715.35 | $5,011.87 | $32,359.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,344.23 / $2,344.23
| Facility | | $2,344.23 | $2,344.23 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,754.23 / $7,079.46
| Professional | | $1,584.89 | $2,754.23 | $7,079.46 |
- 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
- $1,412.54 / $3,548.13 / $6,918.31
| Facility | | $1,412.54 | $3,548.13 | $6,918.31 |