- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $5,495.41 / $16,982.44
| Facility | | $398.11 | $5,495.41 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $1,548.82 / $6,025.60
| Professional | | $177.83 | $1,548.82 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $25,118.86 / $31,622.78
| Facility | | $5,128.61 | $25,118.86 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $0.02 / $0.02
| Professional | | $0.02 | $0.02 | $0.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $74,131.02 / $74,131.02 / $75,857.76
| Facility | | $74,131.02 | $74,131.02 | $75,857.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,288.25 / $1,318.26
| Facility | | $758.58 | $1,288.25 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,513.56 / $1,513.56
| Professional | | $1,513.56 | $1,513.56 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $9,549.93 / $16,218.10
| Facility | | $4,365.16 | $9,549.93 | $16,218.10 |