- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $4,466.84 / $14,125.38
| Facility | | $1,096.48 | $4,466.84 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $8,709.64 / $17,378.01
| Facility | | $4,265.80 | $8,709.64 | $17,378.01 |
- 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 / $1,445.44 / $4,073.80
| Professional | | $891.25 | $1,445.44 | $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 / $6,456.54 / $15,488.17
| Facility | | $2,570.40 | $6,456.54 | $15,488.17 |