- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $4,168.69 / $11,481.54
| Facility | | $1,258.93 | $4,168.69 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,848.93 / $19,054.61 / $42,657.95
| Facility | | $15,848.93 | $19,054.61 | $42,657.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $3,467.37 / $10,715.19
| Professional | | $1,995.26 | $3,467.37 | $10,715.19 |
- 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
- $1,949.84 / $8,128.31 / $28,840.32
| Facility | | $1,949.84 | $8,128.31 | $28,840.32 |