- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $4,897.79 / $13,489.63
| Facility | | $1,096.48 | $4,897.79 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $15,488.17 / $19,498.45
| Facility | | $7,244.36 | $15,488.17 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $11,481.54 / $12,589.25
| Facility | | $7,585.78 | $11,481.54 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,412.54 / $4,073.80
| Professional | | $812.83 | $1,412.54 | $4,073.80 |
- 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
- $2,570.40 / $7,943.28 / $16,982.44
| Facility | | $2,570.40 | $7,943.28 | $16,982.44 |