- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $3,548.13 / $8,912.51
| Facility | | $1,071.52 | $3,548.13 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $5,011.87 / $23,442.29
| Facility | | $3,715.35 | $5,011.87 | $23,442.29 |
- 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
- $1,122.02 / $1,819.70 / $6,309.57
| Professional | | $1,122.02 | $1,819.70 | $6,309.57 |
- 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
- $1,096.48 / $2,398.83 / $5,128.61
| Facility | | $1,096.48 | $2,398.83 | $5,128.61 |