- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $5,370.32 / $20,892.96
| Facility | | $1,621.81 | $5,370.32 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,620.87 / $25,118.86 / $38,018.94
| Facility | | $18,620.87 | $25,118.86 | $38,018.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,782.79 / $26,302.68 / $28,840.32
| Facility | | $17,782.79 | $26,302.68 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.70 / $3,162.28 / $13,489.63
| Professional | | $1,819.70 | $3,162.28 | $13,489.63 |
- 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 / $7,943.28 / $17,378.01
| Facility | | $2,570.40 | $7,943.28 | $17,378.01 |