- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64,565.42 / $64,565.42 / $87,096.36
| Facility | | $64,565.42 | $64,565.42 | $87,096.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,122.02 / $1,122.02
| Facility | | $1,122.02 | $1,122.02 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,122.02 / $1,122.02
| Professional | | $1,122.02 | $1,122.02 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $436.52 / $1,202.26
| Facility | | $426.58 | $436.52 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $436.52 / $1,202.26
| Professional | | $426.58 | $436.52 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,122.02 / $1,122.02
| Facility | | $1,122.02 | $1,122.02 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $239.88 / $1,122.02
| Professional | | $79.43 | $239.88 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $588.84 / $660.69
| Professional | | $537.03 | $588.84 | $660.69 |