- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,596.26 / $3,596.26 / $62,049.10
| Professional | | $3,596.26 | $3,596.26 | $62,049.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,702.96 / $35,749.05 / $68,785.35
| Facility | | $16,702.96 | $35,749.05 | $68,785.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,210.55 / $4,795.70 / $29,172.31
| Professional | | $1,210.55 | $4,795.70 | $29,172.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,350.32 / $31,695.53 / $76,247.88
| Facility | | $22,350.32 | $31,695.53 | $76,247.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,444.73 / $12,733.35 / $36,457.62
| Professional | | $1,444.73 | $12,733.35 | $36,457.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,598.68 / $28,977.31 / $60,037.70
| Facility | | $17,598.68 | $28,977.31 | $60,037.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,335.69 / $4,296.42 / $29,531.24
| Professional | | $1,335.69 | $4,296.42 | $29,531.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,098.44 / $14,449.48 / $46,518.43
| Facility | | $1,098.44 | $14,449.48 | $46,518.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14,301.57 / $27,594.70 / $49,217.96
| Professional | | $14,301.57 | $27,594.70 | $49,217.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,563.50 / $22,799.10 / $46,995.18
| Professional | | $11,563.50 | $22,799.10 | $46,995.18 |