- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $5,370.32 / $14,454.40
| Facility | | $1,288.25 | $5,370.32 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,848.93 / $19,054.61 / $42,657.95
| Facility | | $15,848.93 | $19,054.61 | $42,657.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,848.93 / $15,848.93 / $15,848.93
| Facility | | $15,848.93 | $15,848.93 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $3,311.31 / $12,882.50
| Professional | | $2,041.74 | $3,311.31 | $12,882.50 |
- 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 / $8,912.51 / $25,703.96
| Facility | | $2,570.40 | $8,912.51 | $25,703.96 |