- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $10,715.19 / $17,378.01
| Facility | | $7,943.28 | $10,715.19 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,230.27 / $1,230.27
| Professional | | $1,230.27 | $1,230.27 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $10,715.19 / $20,417.38
| Facility | | $7,079.46 | $10,715.19 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $18,197.01 / $20,417.38
| Professional | | $1,230.27 | $18,197.01 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $14,125.38 / $14,125.38
| Facility | | $2,089.30 | $14,125.38 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659,586.91 / $1,659,586.91 / $1,659,586.91
| Facility | | $1,659,586.91 | $1,659,586.91 | $1,659,586.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $79.43 / $79.43
| Professional | | $70.79 | $79.43 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,489.63 / $18,197.01 / $21,877.62
| Facility | | $13,489.63 | $18,197.01 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $17,782.79 / $26,302.68
| Facility | | $2,884.03 | $17,782.79 | $26,302.68 |