- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $3,715.35 / $9,772.37
| Facility | | $1,023.29 | $3,715.35 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $11,748.98 / $22,908.68
| Facility | | $4,365.16 | $11,748.98 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,479.11 / $3,311.31
| Professional | | $891.25 | $1,479.11 | $3,311.31 |
- 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
- $1,174.90 / $3,388.44 / $6,165.95
| Facility | | $1,174.90 | $3,388.44 | $6,165.95 |