- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,079.48 / $3,079.48 / $61,857.80
| Professional | | $3,079.48 | $3,079.48 | $61,857.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,702.96 / $33,233.65 / $68,785.35
| Facility | | $16,702.96 | $33,233.65 | $68,785.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,045.94 / $4,143.58 / $28,670.82
| Professional | | $1,045.94 | $4,143.58 | $28,670.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,981.41 / $31,172.36 / $74,989.34
| Facility | | $21,981.41 | $31,172.36 | $74,989.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,286.53 / $14,202.63 / $35,719.55
| Professional | | $1,286.53 | $14,202.63 | $35,719.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,869.30 / $28,499.02 / $59,046.73
| Facility | | $17,869.30 | $28,499.02 | $59,046.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,144.35 / $3,680.98 / $28,933.39
| Professional | | $1,144.35 | $3,680.98 | $28,933.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $942.77 / $14,151.98 / $46,518.43
| Facility | | $942.77 | $14,151.98 | $46,518.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,799.57 / $27,445.63 / $49,066.42
| Professional | | $13,799.57 | $27,445.63 | $49,066.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14,708.97 / $25,969.54 / $46,850.49
| Professional | | $14,708.97 | $25,969.54 | $46,850.49 |