- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $5,495.41 / $17,782.79
| Facility | | $1,412.54 | $5,495.41 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,848.93 / $19,054.61 / $39,810.72
| Facility | | $15,848.93 | $19,054.61 | $39,810.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $15,135.61 / $19,498.45
| Facility | | $2,511.89 | $15,135.61 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $3,388.44 / $11,748.98
| Professional | | $1,905.46 | $3,388.44 | $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
- $2,570.40 / $7,943.28 / $16,982.44
| Facility | | $2,570.40 | $7,943.28 | $16,982.44 |