- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $5,623.41 / $18,620.87
| Facility | | $1,202.26 | $5,623.41 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,471.29 / $34,673.69 / $46,773.51
| Facility | | $10,471.29 | $34,673.69 | $46,773.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $10,000.00 / $28,840.32
| Facility | | $5,754.40 | $10,000.00 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,659.59 / $6,309.57
| Professional | | $1,047.13 | $1,659.59 | $6,309.57 |
- 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 / $17,378.01
| Facility | | $2,570.40 | $7,943.28 | $17,378.01 |