- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $5,623.41 / $18,620.87
| Facility | | $1,202.26 | $5,623.41 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $8,709.64 / $17,782.79
| Facility | | $4,365.16 | $8,709.64 | $17,782.79 |
- 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
- $891.25 / $1,548.82 / $5,011.87
| Professional | | $891.25 | $1,548.82 | $5,011.87 |
- 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
- $2,089.30 / $5,495.41 / $12,302.69
| Facility | | $2,089.30 | $5,495.41 | $12,302.69 |