- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $5,754.40 / $12,022.64
| Facility | | $2,570.40 | $5,754.40 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $10,232.93 / $15,488.17
| Professional | | $1,023.29 | $10,232.93 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $11,220.18 / $19,054.61
| Facility | | $5,011.87 | $11,220.18 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.57 / $64.57 / $53,703.18
| Facility | | $64.57 | $64.57 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,000.00 / $10,000.00 / $10,000.00
| Professional | | $10,000.00 | $10,000.00 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34,673.69 / $34,673.69 / $34,673.69
| Facility | | $34,673.69 | $34,673.69 | $34,673.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50,118.72 / $53,703.18 / $75,857.76
| Facility | | $50,118.72 | $53,703.18 | $75,857.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $10,232.93 / $29,512.09
| Facility | | $2,818.38 | $10,232.93 | $29,512.09 |