- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $4,466.84 / $12,022.64
| Facility | | $1,258.93 | $4,466.84 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $11,220.18 / $35,481.34
| Facility | | $9,332.54 | $11,220.18 | $35,481.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $10,715.19 / $17,378.01
| Facility | | $9,120.11 | $10,715.19 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,754.23 / $9,332.54
| Professional | | $1,698.24 | $2,754.23 | $9,332.54 |
- 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 / $6,309.57 / $16,982.44
| Facility | | $2,570.40 | $6,309.57 | $16,982.44 |