- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,981.07 / $5,011.87
| Facility | | $2,290.87 | $3,981.07 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $26,915.35 / $51,286.14
| Facility | | $10,000.00 | $26,915.35 | $51,286.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $3,801.89 / $6,760.83
| Professional | | $2,187.76 | $3,801.89 | $6,760.83 |
- 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
- $616.60 / $2,884.03 / $7,413.10
| Facility | | $616.60 | $2,884.03 | $7,413.10 |