- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $6,760.83 / $44,668.36
| Facility | | $1,288.25 | $6,760.83 | $44,668.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $15,135.61 / $29,512.09
| Facility | | $2,754.23 | $15,135.61 | $29,512.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $14,125.38 / $19,054.61
| Facility | | $4,677.35 | $14,125.38 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,513.56 / $6,165.95
| Professional | | $954.99 | $1,513.56 | $6,165.95 |
- 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
- $2,630.27 / $10,471.29 / $43,651.58
| Facility | | $2,630.27 | $10,471.29 | $43,651.58 |