- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $5,888.44 / $16,218.10
| Facility | | $1,621.81 | $5,888.44 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,096.48 / $1,380.38
| Professional | | $1,096.48 | $1,096.48 | $1,380.38 |
- 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 / $691.83 / $870.96
| Professional | | $0.02 | $691.83 | $870.96 |
- 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 / $1,548.82 / $1,548.82
| Facility | | $758.58 | $1,548.82 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.70 / $1,819.70 / $10,000.00
| Professional | | $1,819.70 | $1,819.70 | $10,000.00 |
- 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 |