- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $3,890.45 / $8,511.38
| Facility | | $1,148.15 | $3,890.45 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,471.29 / $28,183.83 / $54,954.09
| Facility | | $10,471.29 | $28,183.83 | $54,954.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $3,467.37 / $10,964.78
| Professional | | $2,089.30 | $3,467.37 | $10,964.78 |
- 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 |