- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $3,235.94 / $10,964.78
| Facility | | $1,202.26 | $3,235.94 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $19,054.61 / $37,153.52
| Facility | | $7,079.46 | $19,054.61 | $37,153.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,344.23 / $7,762.47
| Professional | | $1,380.38 | $2,344.23 | $7,762.47 |
- 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
- $575.44 / $2,884.03 / $7,413.10
| Facility | | $575.44 | $2,884.03 | $7,413.10 |