- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $14,125.38 / $23,442.29
| Facility | | $5,248.07 | $14,125.38 | $23,442.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $1,348.96 / $3,890.45
| Professional | | $147.91 | $1,348.96 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81,283.05 / $81,283.05 / $81,283.05
| Facility | | $81,283.05 | $81,283.05 | $81,283.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72,443.60 / $72,443.60 / $72,443.60
| Professional | | $72,443.60 | $72,443.60 | $72,443.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $34.67 / $34.67
| Facility | | $34.67 | $34.67 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,630.78 / $3,630.78 / $3,630.78
| Professional | | $3,630.78 | $3,630.78 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $22,387.21 / $38,904.51
| Facility | | $9,549.93 | $22,387.21 | $38,904.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $3,548.13 / $16,982.44
| Facility | | $3,548.13 | $3,548.13 | $16,982.44 |