- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $3,981.07 / $9,772.37
| Facility | | $1,122.02 | $3,981.07 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $8,511.38 / $12,302.69
| Facility | | $4,265.80 | $8,511.38 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $660.69 / $831.76
| Facility | | $660.69 | $660.69 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,905.46 / $3,467.37
| Professional | | $724.44 | $1,905.46 | $3,467.37 |
- 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
- $1,659.59 / $6,165.95 / $15,488.17
| Facility | | $1,659.59 | $6,165.95 | $15,488.17 |