- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $6,309.57 / $27,542.29
| Facility | | $776.25 | $6,309.57 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $8,709.64 / $17,782.79
| Facility | | $3,388.44 | $8,709.64 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $891.25 / $7,585.78
| Facility | | $575.44 | $891.25 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,479.11
| Professional | | $1,000.00 | $1,000.00 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $870.96 / $1,412.54
| Facility | | $630.96 | $870.96 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $20,417.38 / $25,703.96
| Facility | | $4,677.35 | $20,417.38 | $25,703.96 |