- 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 / $38,018.94
| Facility | | $15,848.93 | $19,054.61 | $38,018.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $15,135.61 / $19,498.45
| Facility | | $4,677.35 | $15,135.61 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,818.38 / $9,772.37
| Professional | | $1,778.28 | $2,818.38 | $9,772.37 |
- 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 |