- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $5,623.41 / $18,620.87
| Facility | | $1,174.90 | $5,623.41 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $10,471.29 / $16,218.10
| Facility | | $7,943.28 | $10,471.29 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $10,964.78 / $12,589.25
| Facility | | $5,248.07 | $10,964.78 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,230.27 / $3,162.28
| Professional | | $776.25 | $1,230.27 | $3,162.28 |
- 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 / $6,309.57 / $16,982.44
| Facility | | $2,570.40 | $6,309.57 | $16,982.44 |