- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $4,168.69 / $18,620.87
| Facility | | $1,047.13 | $4,168.69 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $38,904.51 / $52,480.75
| Facility | | $9,772.37 | $38,904.51 | $52,480.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,412.54 / $3,801.89
| Professional | | $851.14 | $1,412.54 | $3,801.89 |
- 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
- $3,467.37 / $18,197.01 / $50,118.72
| Facility | | $3,467.37 | $18,197.01 | $50,118.72 |