- 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
- $15,488.17 / $25,118.86 / $33,113.11
| Facility | | $15,488.17 | $25,118.86 | $33,113.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $2,398.83 / $5,370.32
| Professional | | $1,412.54 | $2,398.83 | $5,370.32 |
- 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 |