- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $4,466.84 / $8,511.38
| Facility | | $1,148.15 | $4,466.84 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $37,153.52 / $70,794.58
| Facility | | $13,803.84 | $37,153.52 | $70,794.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,801.89 / $15,488.17
| Professional | | $2,398.83 | $3,801.89 | $15,488.17 |
- 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
- $575.44 / $2,884.03 / $7,413.10
| Facility | | $575.44 | $2,884.03 | $7,413.10 |