- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $4,073.80 / $9,772.37
| Facility | | $1,122.02 | $4,073.80 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $18,620.87 / $22,387.21
| Facility | | $9,549.93 | $18,620.87 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $12,589.25 / $16,982.44
| Facility | | $5,248.07 | $12,589.25 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,513.56 / $4,466.84
| Professional | | $954.99 | $1,513.56 | $4,466.84 |
- 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
- $2,137.96 / $6,606.93 / $12,882.50
| Facility | | $2,137.96 | $6,606.93 | $12,882.50 |