- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,152.21 / $3,368.00 / $7,694.03
| Facility | | $1,152.21 | $3,368.00 | $7,694.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,295.45 / $9,156.54 / $19,971.57
| Facility | | $4,295.45 | $9,156.54 | $19,971.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.00 / $3,072.73 / $3,430.33
| Facility | | $875.00 | $3,072.73 | $3,430.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $938.39 / $1,407.35 / $3,871.89
| Professional | | $938.39 | $1,407.35 | $3,871.89 |
- 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
- $1,600.00 / $4,530.00 / $8,566.00
| Facility | | $1,600.00 | $4,530.00 | $8,566.00 |