- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.61 / $990.17 / $19,287.20
| Facility | | $758.61 | $990.17 | $19,287.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $990.17 / $19,287.20 / $26,415.80
| Professional | | $990.17 | $19,287.20 | $26,415.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,141.25 / $2,711.49 / $40,491.19
| Professional | | $2,141.25 | $2,711.49 | $40,491.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.70 / $13,351.08 / $15,275.28
| Professional | | $1,071.70 | $13,351.08 | $15,275.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42,046.12 / $77,482.28 / $94,668.37
| Facility | | $42,046.12 | $77,482.28 | $94,668.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $484.11 / $10,538.61 / $18,883.07
| Professional | | $484.11 | $10,538.61 | $18,883.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,483.64 / $12,196.26 / $32,467.93
| Professional | | $8,483.64 | $12,196.26 | $32,467.93 |