- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $4,265.80 / $6,760.83
| Facility | | $933.25 | $4,265.80 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $1,202.26 / $3,162.28
| Facility | | $323.59 | $1,202.26 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,000.00
| Professional | | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $851.14 / $1,348.96
| Facility | | $660.69 | $851.14 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $3,890.45 / $9,549.93
| Facility | | $912.01 | $3,890.45 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,715.19 / $10,715.19 / $19,498.45
| Facility | | $10,715.19 | $10,715.19 | $19,498.45 |