- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,079.48 / $3,079.48 / $61,857.80
| Professional | | $3,079.48 | $3,079.48 | $61,857.80 |
- 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
- $915.42 / $915.42 / $13,497.81
| Professional | | $915.42 | $915.42 | $13,497.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,007.87 / $20,007.87 / $20,007.87
| Facility | | $20,007.87 | $20,007.87 | $20,007.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,419.27 / $8,419.27 / $10,251.65
| Professional | | $8,419.27 | $8,419.27 | $10,251.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,147.12 / $19,255.21 / $24,450.48
| Professional | | $16,147.12 | $19,255.21 | $24,450.48 |