- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $3,801.89 / $12,882.50
| Facility | | $1,122.02 | $3,801.89 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $18,197.01 / $22,387.21
| Facility | | $8,128.31 | $18,197.01 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,498.45 / $19,498.45 / $19,498.45
| Facility | | $19,498.45 | $19,498.45 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,258.93 / $3,630.78
| Professional | | $794.33 | $1,258.93 | $3,630.78 |
- 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 / $16,982.44
| Facility | | $2,570.40 | $7,943.28 | $16,982.44 |