- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $5,888.44 / $30,199.52
| Facility | | $1,862.09 | $5,888.44 | $30,199.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,892.96 / $38,904.51 / $48,977.88
| Facility | | $20,892.96 | $38,904.51 | $48,977.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $15,135.61 / $19,498.45
| Facility | | $4,677.35 | $15,135.61 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $3,548.13 / $13,182.57
| Professional | | $1,995.26 | $3,548.13 | $13,182.57 |
- 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
- $3,090.30 / $14,125.38 / $38,018.94
| Facility | | $3,090.30 | $14,125.38 | $38,018.94 |