- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $4,466.84 / $11,220.18
| Facility | | $1,023.29 | $4,466.84 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $8,128.31 / $10,964.78
| Facility | | $4,265.80 | $8,128.31 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $831.76 / $5,623.41
| Facility | | $660.69 | $831.76 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $977.24 / $3,019.95
| Professional | | $575.44 | $977.24 | $3,019.95 |
- 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
- $1,905.46 / $5,370.32 / $12,302.69
| Facility | | $1,905.46 | $5,370.32 | $12,302.69 |