- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $3,235.94 / $9,772.37
| Facility | | $1,202.26 | $3,235.94 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $18,620.87 / $35,481.34
| Facility | | $6,918.31 | $18,620.87 | $35,481.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $11,748.98 / $12,882.50
| Facility | | $7,762.47 | $11,748.98 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,238.72 / $5,888.44
| Professional | | $1,380.38 | $2,238.72 | $5,888.44 |
- 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
- $891.25 / $2,137.96 / $4,570.88
| Facility | | $891.25 | $2,137.96 | $4,570.88 |