- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $4,265.80 / $10,232.93
| Facility | | $3,162.28 | $4,265.80 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $2,238.72 / $2,630.27
| Professional | | $457.09 | $2,238.72 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $2,754.23 / $8,317.64
| Facility | | $2,754.23 | $2,754.23 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.22 / $13.18 / $2,344.23
| Professional | | $11.22 | $13.18 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $39,810.72 / $60,255.96
| Facility | | $2,691.53 | $39,810.72 | $60,255.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $1,778.28 / $10,715.19
| Facility | | $1,778.28 | $1,778.28 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.38 / $3,388.44 / $8,317.64
| Professional | | $17.38 | $3,388.44 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $2,754.23 / $2,754.23
| Facility | | $2,754.23 | $2,754.23 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,659.59 / $2,754.23
| Professional | | $1,148.15 | $1,659.59 | $2,754.23 |