- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,706.14 / $4,813.58 / $15,000.00
| Facility | | $3,706.14 | $4,813.58 | $15,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $513.03 / $976.90 / $1,036.74
| Professional | | $513.03 | $976.90 | $1,036.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39,186.76 / $49,509.24 / $71,493.00
| Facility | | $39,186.76 | $49,509.24 | $71,493.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,807.00 / $10,745.00 / $74,646.00
| Facility | | $6,807.00 | $10,745.00 | $74,646.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $963.52 / $1,301.38 / $2,099.67
| Professional | | $963.52 | $1,301.38 | $2,099.67 |