- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $3,801.89 / $8,912.51
| Facility | | $1,202.26 | $3,801.89 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $4,168.69 / $11,220.18
| Professional | | $2,511.89 | $4,168.69 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56,234.13 / $63,095.73 / $75,857.76
| Facility | | $56,234.13 | $63,095.73 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $199.53 / $20,892.96
| Professional | | $120.23 | $199.53 | $20,892.96 |
- 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
- $2,570.40 / $9,772.37 / $34,673.69
| Facility | | $2,570.40 | $9,772.37 | $34,673.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,549.93 / $14,454.40 / $22,387.21
| Professional | | $9,549.93 | $14,454.40 | $22,387.21 |