- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $4,786.30 / $8,511.38
| Facility | | $1,862.09 | $4,786.30 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $1,621.81 / $4,786.30
| Professional | | $331.13 | $1,621.81 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $16,218.10 / $18,620.87
| Facility | | $8,709.64 | $16,218.10 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $0.02 / $11,220.18
| Professional | | $0.02 | $0.02 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,000.00
| Facility | | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $501.19 / $501.19
| Facility | | $501.19 | $501.19 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54,954.09 / $54,954.09 / $54,954.09
| Professional | | $54,954.09 | $54,954.09 | $54,954.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $371.54 / $812.83
| Professional | | $371.54 | $371.54 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $8,709.64 / $13,803.84
| Facility | | $1,202.26 | $8,709.64 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $60.26 / $61.66
| Professional | | $50.12 | $60.26 | $61.66 |