- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $13,182.57 / $28,183.83
| Facility | | $4,466.84 | $13,182.57 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,488.17 / $15,488.17 / $15,488.17
| Professional | | $15,488.17 | $15,488.17 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,512.09 / $29,512.09 / $29,512.09
| Facility | | $29,512.09 | $29,512.09 | $29,512.09 |
- 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
- $16,218.10 / $75,857.76 / $134,896.29
| Facility | | $16,218.10 | $75,857.76 | $134,896.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,220.18 / $42,657.95 / $42,657.95
| Facility | | $11,220.18 | $42,657.95 | $42,657.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35,481.34 / $50,118.72 / $95,499.26
| Facility | | $35,481.34 | $50,118.72 | $95,499.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $64,565.42 / $109,647.82
| Facility | | $8,511.38 | $64,565.42 | $109,647.82 |