- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $4,073.80 / $8,511.38
| Facility | | $1,148.15 | $4,073.80 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $24,547.09 / $46,773.51
| Facility | | $9,120.11 | $24,547.09 | $46,773.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $398.11 / $588.84
| Facility | | $398.11 | $398.11 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $3,890.45 / $12,022.64
| Professional | | $2,187.76 | $3,890.45 | $12,022.64 |
- 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
- $562.34 / $2,818.38 / $7,413.10
| Facility | | $562.34 | $2,818.38 | $7,413.10 |