- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $6,760.83 / $33,884.42
| Facility | | $6,456.54 | $6,760.83 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $15,488.17 / $15,488.17
| Professional | | $2,818.38 | $15,488.17 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,183.83 / $50,118.72 / $128,824.96
| Facility | | $28,183.83 | $50,118.72 | $128,824.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.57 / $64.57 / $64.57
| Facility | | $64.57 | $64.57 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,000.00 / $10,000.00 / $10,000.00
| Professional | | $10,000.00 | $10,000.00 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $12,589.25 / $46,773.51
| Facility | | $7,585.78 | $12,589.25 | $46,773.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $11,220.18 / $46,773.51
| Facility | | $1,584.89 | $11,220.18 | $46,773.51 |