- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,521.79 / $109,763.25 / $132,183.59
| Facility | | $3,521.79 | $109,763.25 | $132,183.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,179.97 / $1,202.27 / $1,377.75
| Professional | | $1,179.97 | $1,202.27 | $1,377.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,070.48 / $12,070.48 / $12,070.48
| Facility | | $12,070.48 | $12,070.48 | $12,070.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,210.47 / $1,414.65 / $2,518.48
| Professional | | $1,210.47 | $1,414.65 | $2,518.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,532.23 / $17,532.23 / $17,532.23
| Facility | | $17,532.23 | $17,532.23 | $17,532.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,381.93 / $1,381.93 / $1,815.71
| Professional | | $1,381.93 | $1,381.93 | $1,815.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,783.00 / $2,783.00 / $2,783.00
| Facility | | $2,783.00 | $2,783.00 | $2,783.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,161.69 / $1,378.64 / $3,138.95
| Professional | | $1,161.69 | $1,378.64 | $3,138.95 |