- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $5,495.41 / $12,302.69
| Facility | | $1,047.13 | $5,495.41 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $3,467.37 / $5,370.32
| Professional | | $1,174.90 | $3,467.37 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $16,595.87 / $53,703.18
| Facility | | $8,317.64 | $16,595.87 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25,118.86 / $25,118.86 / $25,118.86
| Professional | | $25,118.86 | $25,118.86 | $25,118.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,623.41 / $8,128.31 / $8,317.64
| Professional | | $5,623.41 | $8,128.31 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $5,011.87
| Professional | | $32.36 | $33.11 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $15,135.61 / $23,442.29
| Facility | | $6,165.95 | $15,135.61 | $23,442.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,318.26 / $4,073.80
| Professional | | $776.25 | $1,318.26 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $1,949.84 / $1,949.84
| Professional | | $1,949.84 | $1,949.84 | $1,949.84 |