- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $11,481.54 / $18,197.01
| Facility | | $6,456.54 | $11,481.54 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $13,489.63 / $53,703.18
| Professional | | $1,698.24 | $13,489.63 | $53,703.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $56.23 / $69,183.10
| Facility | | $54.95 | $56.23 | $69,183.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79,432.82 / $93,325.43 / $93,325.43
| Professional | | $79,432.82 | $93,325.43 | $93,325.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,332.54 / $9,332.54 / $15,488.17
| Professional | | $9,332.54 | $9,332.54 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $1,949.84 / $33,113.11
| Professional | | $1,778.28 | $1,949.84 | $33,113.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $2,398.83 / $47,863.01
| Professional | | $2,398.83 | $2,398.83 | $47,863.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $10,715.19 / $26,915.35
| Professional | | $724.44 | $10,715.19 | $26,915.35 |