- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $47,863.01 / $70,794.58
| Facility | | $2,187.76 | $47,863.01 | $70,794.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,047.13 / $2,089.30
| Professional | | $776.25 | $1,047.13 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $23,988.33 / $48,977.88
| Facility | | $1,905.46 | $23,988.33 | $48,977.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,479.11 / $2,454.71
| Professional | | $1,148.15 | $1,479.11 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $2,818.38 / $22,908.68
| Facility | | $316.23 | $2,818.38 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $6,309.57 / $6,918.31
| Professional | | $1,659.59 | $6,309.57 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,995.26 / $29,512.09
| Professional | | $1,318.26 | $1,995.26 | $29,512.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,235.94 / $3,548.13
| Professional | | $3,090.30 | $3,235.94 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,318.26 / $5,888.44
| Facility | | $1,318.26 | $1,318.26 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $2,290.87 / $5,370.32
| Professional | | $1,096.48 | $2,290.87 | $5,370.32 |