- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $4,466.84 / $11,481.54
| Facility | | $1,258.93 | $4,466.84 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,848.93 / $18,620.87 / $36,307.81
| Facility | | $15,848.93 | $18,620.87 | $36,307.81 |
- 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
- $1,698.24 / $2,691.53 / $9,332.54
| Professional | | $1,698.24 | $2,691.53 | $9,332.54 |
- 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 |