- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $3,548.13 / $9,772.37
| Facility | | $1,148.15 | $3,548.13 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $12,589.25 / $23,988.33
| Facility | | $4,677.35 | $12,589.25 | $23,988.33 |
- 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
- $1,071.52 / $2,041.74 / $4,466.84
| Professional | | $1,071.52 | $2,041.74 | $4,466.84 |
- 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
- $1,288.25 / $5,623.41 / $12,302.69
| Facility | | $1,288.25 | $5,623.41 | $12,302.69 |