- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $3,548.13 / $8,511.38
| Facility | | $1,202.26 | $3,548.13 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,182.57 / $25,118.86 / $30,902.95
| Facility | | $13,182.57 | $25,118.86 | $30,902.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,542.29 / $27,542.29 / $27,542.29
| Facility | | $27,542.29 | $27,542.29 | $27,542.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $2,089.30 / $6,025.60
| Professional | | $1,318.26 | $2,089.30 | $6,025.60 |
- 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 |