- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $5,888.44 / $10,964.78
| Facility | | $2,511.89 | $5,888.44 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $8,317.64 / $18,197.01
| Professional | | $1,548.82 | $8,317.64 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $22,387.21 / $38,018.94
| Facility | | $12,882.50 | $22,387.21 | $38,018.94 |
- 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
- $26,302.68 / $26,302.68 / $26,302.68
| Facility | | $26,302.68 | $26,302.68 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $15,135.61 / $30,199.52
| Facility | | $10,000.00 | $15,135.61 | $30,199.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,000.00 / $15,135.61 / $30,199.52
| Professional | | $10,000.00 | $15,135.61 | $30,199.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,964.78 / $18,620.87 / $40,738.03
| Facility | | $10,964.78 | $18,620.87 | $40,738.03 |