- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $7,079.46 / $19,498.45
| Facility | | $4,570.88 | $7,079.46 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $2,089.30 / $14,791.08
| Professional | | $562.34 | $2,089.30 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $25,118.86 / $32,359.37
| Facility | | $8,912.51 | $25,118.86 | $32,359.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $8,511.38 / $21,379.62
| Professional | | $977.24 | $8,511.38 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,737.80 / $19,952.62
| Professional | | $741.31 | $1,737.80 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,848.93 / $15,848.93 / $16,218.10
| Professional | | $15,848.93 | $15,848.93 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,380.38 / $1,380.38
| Professional | | $1,380.38 | $1,380.38 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $12,589.25 / $21,877.62
| Facility | | $8,912.51 | $12,589.25 | $21,877.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $8,317.64 / $24,547.09
| Professional | | $645.65 | $8,317.64 | $24,547.09 |