- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $4,897.79 / $7,244.36
| Facility | | $1,380.38 | $4,897.79 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $724.44 / $1,380.38
| Professional | | $218.78 | $724.44 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $6,025.60 / $16,595.87
| Facility | | $3,090.30 | $6,025.60 | $16,595.87 |
- 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
- $851.14 / $851.14 / $870.96
| Facility | | $851.14 | $851.14 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,000.00
| Professional | | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $2,137.96 / $5,754.40
| Facility | | $204.17 | $2,137.96 | $5,754.40 |