- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $3,890.45 / $8,511.38
| Facility | | $1,148.15 | $3,890.45 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $23,988.33 / $46,773.51
| Facility | | $8,912.51 | $23,988.33 | $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
- $1,905.46 / $3,890.45 / $9,120.11
| Professional | | $1,905.46 | $3,890.45 | $9,120.11 |
- 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
- $575.44 / $2,818.38 / $7,413.10
| Facility | | $575.44 | $2,818.38 | $7,413.10 |