- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $3,981.07 / $8,511.38
| Facility | | $1,148.15 | $3,981.07 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,022.64 / $32,359.37 / $61,659.50
| Facility | | $12,022.64 | $32,359.37 | $61,659.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,715.35 / $12,302.69
| Professional | | $2,290.87 | $3,715.35 | $12,302.69 |
- 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 |