- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,240.00 / $3,042.00 / $6,083.67
| Facility | | $2,240.00 | $3,042.00 | $6,083.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,671.00 / $4,589.00 / $6,006.00
| Facility | | $3,671.00 | $4,589.00 | $6,006.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,773.05 / $1,773.05 / $1,773.05
| Facility | | $1,773.05 | $1,773.05 | $1,773.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.05 / $602.23 / $2,276.64
| Professional | | $10.05 | $602.23 | $2,276.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,821.31 / $3,900.25 / $3,900.25
| Facility | | $1,821.31 | $3,900.25 | $3,900.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,642.00 / $3,000.00 / $9,042.00
| Facility | | $1,642.00 | $3,000.00 | $9,042.00 |