- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $4,466.84 / $12,022.64
| Facility | | $1,380.38 | $4,466.84 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $15,488.17 / $33,113.11
| Facility | | $8,128.31 | $15,488.17 | $33,113.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $2,238.72 / $6,456.54
| Professional | | $1,412.54 | $2,238.72 | $6,456.54 |
- 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 |