- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $3,548.13 / $8,912.51
| Facility | | $1,148.15 | $3,548.13 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $8,128.31 / $23,442.29
| Facility | | $6,606.93 | $8,128.31 | $23,442.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,659.59 / $4,365.16
| Professional | | $891.25 | $1,659.59 | $4,365.16 |
- 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 / $4,265.80 / $7,585.78
| Facility | | $1,174.90 | $4,265.80 | $7,585.78 |