- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,208.33 / $15,729.58 / $40,626.47
| Facility | | $1,208.33 | $15,729.58 | $40,626.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $419.01 / $521.30 / $8,008.72
| Professional | | $419.01 | $521.30 | $8,008.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,851.90 / $3,851.90 / $3,851.90
| Facility | | $3,851.90 | $3,851.90 | $3,851.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $523.41 / $926.72 / $11,952.14
| Professional | | $523.41 | $926.72 | $11,952.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,544.08 / $7,544.08 / $7,544.08
| Facility | | $7,544.08 | $7,544.08 | $7,544.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $469.22 / $469.22 / $469.22
| Professional | | $469.22 | $469.22 | $469.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,783.00 / $2,783.00 / $2,783.00
| Facility | | $2,783.00 | $2,783.00 | $2,783.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,895.29 / $8,655.96 / $15,001.77
| Professional | | $5,895.29 | $8,655.96 | $15,001.77 |