- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $4,073.80 / $8,511.38
| Facility | | $1,148.15 | $4,073.80 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,964.78 / $29,512.09 / $56,234.13
| Facility | | $10,964.78 | $29,512.09 | $56,234.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,801.89 / $11,748.98
| Professional | | $2,398.83 | $3,801.89 | $11,748.98 |
- 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
- $616.60 / $2,951.21 / $7,413.10
| Facility | | $616.60 | $2,951.21 | $7,413.10 |