- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $31,622.78 / $70,794.58
| Facility | | $1,513.56 | $31,622.78 | $70,794.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,148.15 / $1,659.59
| Professional | | $851.14 | $1,148.15 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $3,388.44 / $47,863.01
| Facility | | $1,412.54 | $3,388.44 | $47,863.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,348.96 / $2,570.40
| Professional | | $1,023.29 | $1,348.96 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $7,943.28 / $47,863.01
| Facility | | $1,122.02 | $7,943.28 | $47,863.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,818.38 / $5,248.07
| Professional | | $1,819.70 | $2,818.38 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $9,772.37 / $27,542.29
| Facility | | $5,623.41 | $9,772.37 | $27,542.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,819.70 / $3,981.07
| Professional | | $1,000.00 | $1,819.70 | $3,981.07 |