- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $15,488.17 / $21,877.62
| Facility | | $2,344.23 | $15,488.17 | $21,877.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,174.90 / $1,380.38
| Professional | | $1,174.90 | $1,174.90 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $25,118.86 / $31,622.78
| Facility | | $5,248.07 | $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
- $457.09 / $457.09 / $467.74
| Facility | | $457.09 | $457.09 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $537.03 / $537.03
| Professional | | $537.03 | $537.03 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $9,549.93 / $16,218.10
| Facility | | $4,466.84 | $9,549.93 | $16,218.10 |