- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $2,884.03 / $9,332.54
| Facility | | $1,071.52 | $2,884.03 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $10,471.29 / $14,791.08
| Facility | | $7,079.46 | $10,471.29 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,174.90 / $3,801.89
| Professional | | $707.95 | $1,174.90 | $3,801.89 |
- 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
- $2,137.96 / $6,025.60 / $12,882.50
| Facility | | $2,137.96 | $6,025.60 | $12,882.50 |