- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $2,884.03 / $7,762.47
| Facility | | $1,202.26 | $2,884.03 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $10,964.78 / $28,183.83
| Facility | | $9,120.11 | $10,964.78 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,398.83 / $5,888.44
| Professional | | $1,380.38 | $2,398.83 | $5,888.44 |
- 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
- $1,230.27 / $3,981.07 / $8,912.51
| Facility | | $1,230.27 | $3,981.07 | $8,912.51 |