- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $15,848.93 / $46,773.51
| Facility | | $741.31 | $15,848.93 | $46,773.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,047.13 / $1,778.28
| Professional | | $741.31 | $1,047.13 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $23,988.33 / $34,673.69
| Facility | | $7,762.47 | $23,988.33 | $34,673.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,659.59 / $6,456.54
| Professional | | $977.24 | $1,659.59 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,202.26 / $1,288.25
| Professional | | $912.01 | $1,202.26 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $776.25 / $1,659.59
| Professional | | $562.34 | $776.25 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $6,165.95 / $8,912.51
| Facility | | $794.33 | $6,165.95 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,621.81 / $3,311.31
| Professional | | $1,023.29 | $1,621.81 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $676.08 / $1,202.26
| Professional | | $676.08 | $676.08 | $1,202.26 |