- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $3,548.13 / $14,791.08
| Facility | | $1,071.52 | $3,548.13 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $18,197.01 / $22,387.21
| Facility | | $8,317.64 | $18,197.01 | $22,387.21 |
- 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
- $831.76 / $1,318.26 / $4,073.80
| Professional | | $831.76 | $1,318.26 | $4,073.80 |
- 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 / $16,982.44
| Facility | | $2,570.40 | $7,943.28 | $16,982.44 |