- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $2,691.53 / $7,762.47
| Facility | | $1,071.52 | $2,691.53 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $5,011.87 / $28,183.83
| Facility | | $3,981.07 | $5,011.87 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,344.23 / $6,165.95
| Professional | | $1,479.11 | $2,344.23 | $6,165.95 |
- 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
- $1,288.25 / $3,548.13 / $7,585.78
| Facility | | $1,288.25 | $3,548.13 | $7,585.78 |