- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $5,370.32 / $24,547.09
| Facility | | $1,258.93 | $5,370.32 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $15,488.17 / $29,512.09
| Facility | | $7,244.36 | $15,488.17 | $29,512.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,041.74 / $6,309.57
| Professional | | $1,258.93 | $2,041.74 | $6,309.57 |
- 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
- $2,570.40 / $7,943.28 / $16,982.44
| Facility | | $2,570.40 | $7,943.28 | $16,982.44 |