- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,271.78 / $2,271.78 / $18,681.90
| Professional | | $2,271.78 | $2,271.78 | $18,681.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47,000.00 / $81,499.99 / $94,999.99
| Facility | | $47,000.00 | $81,499.99 | $94,999.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $680.39 / $680.39 / $4,502.43
| Professional | | $680.39 | $680.39 | $4,502.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,080.84 / $7,080.84 / $7,080.84
| Facility | | $7,080.84 | $7,080.84 | $7,080.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,780.94 / $2,780.94 / $3,418.34
| Professional | | $2,780.94 | $2,780.94 | $3,418.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,077.81 / $5,859.01 / $8,152.94
| Professional | | $5,077.81 | $5,859.01 | $8,152.94 |