- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $5,623.41 / $19,498.45
| Facility | | $1,230.27 | $5,623.41 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $8,511.38 / $20,417.38
| Facility | | $5,011.87 | $8,511.38 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,148.15 / $5,623.41
| Facility | | $912.01 | $1,148.15 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $2,187.76 / $6,456.54
| Professional | | $1,288.25 | $2,187.76 | $6,456.54 |
- 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
- $1,905.46 / $5,370.32 / $12,302.69
| Facility | | $1,905.46 | $5,370.32 | $12,302.69 |