- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,642.00 / $3,042.00 / $6,953.00
| Facility | | $1,642.00 | $3,042.00 | $6,953.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,072.00 / $3,931.00 / $5,258.00
| Facility | | $3,072.00 | $3,931.00 | $5,258.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,009.94 / $1,009.94 / $1,009.94
| Facility | | $1,009.94 | $1,009.94 | $1,009.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.58 / $364.32 / $1,307.80
| Professional | | $10.58 | $364.32 | $1,307.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,046.24 / $2,263.96 / $2,263.96
| Facility | | $1,046.24 | $2,263.96 | $2,263.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,282.00 / $2,940.00 / $7,138.00
| Facility | | $1,282.00 | $2,940.00 | $7,138.00 |