- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $3,090.30 / $8,511.38
| Facility | | $1,023.29 | $3,090.30 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,715.19 / $12,589.25 / $21,877.62
| Facility | | $10,715.19 | $12,589.25 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $6,025.60 / $6,025.60
| Facility | | $6,025.60 | $6,025.60 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,698.24 / $7,079.46
| Professional | | $1,071.52 | $1,698.24 | $7,079.46 |
- 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
- $2,137.96 / $5,370.32 / $12,882.50
| Facility | | $2,137.96 | $5,370.32 | $12,882.50 |