- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $7,943.28 / $15,135.61
| Facility | | $4,570.88 | $7,943.28 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,442.29 / $30,199.52 / $58,884.37
| Facility | | $23,442.29 | $30,199.52 | $58,884.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,778.28 / $33,884.42
| Facility | | $1,000.00 | $1,778.28 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,398.83 / $3,162.28
| Professional | | $2,238.72 | $2,398.83 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $4,466.84 / $27,542.29
| Facility | | $1,148.15 | $4,466.84 | $27,542.29 |