- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $7,079.46 / $38,904.51
| Facility | | $1,202.26 | $7,079.46 | $38,904.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,202.26 / $1,995.26
| Professional | | $891.25 | $1,202.26 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,135.61 / $21,379.62 / $35,481.34
| Facility | | $15,135.61 | $21,379.62 | $35,481.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,621.81 / $2,290.87
| Professional | | $1,148.15 | $1,621.81 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $17,782.79 / $30,902.95
| Facility | | $1,071.52 | $17,782.79 | $30,902.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,659.59 / $6,309.57
| Professional | | $1,659.59 | $1,659.59 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14,125.38 / $14,125.38 / $14,125.38
| Professional | | $14,125.38 | $14,125.38 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,949.84 / $1,949.84
| Professional | | $1,513.56 | $1,949.84 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,691.53 / $4,365.16
| Professional | | $1,348.96 | $2,691.53 | $4,365.16 |