- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $3,890.45 / $8,511.38
| Facility | | $1,148.15 | $3,890.45 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $23,442.29 / $44,668.36
| Facility | | $8,709.64 | $23,442.29 | $44,668.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $3,090.30 / $7,079.46
| Professional | | $1,621.81 | $3,090.30 | $7,079.46 |
- 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 |