- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $5,128.61 / $15,135.61
| Facility | | $1,071.52 | $5,128.61 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $9,549.93 / $18,197.01
| Facility | | $1,621.81 | $9,549.93 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $8,317.64 / $19,054.61
| Facility | | $1,122.02 | $8,317.64 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $954.99 / $6,456.54
| Professional | | $616.60 | $954.99 | $6,456.54 |
- 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
- $1,778.28 / $7,413.10 / $16,982.44
| Facility | | $1,778.28 | $7,413.10 | $16,982.44 |