- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $22,387.21 / $61,659.50
| Facility | | $1,513.56 | $22,387.21 | $61,659.50 |
- 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
- $7,943.28 / $9,772.37 / $30,902.95
| Facility | | $7,943.28 | $9,772.37 | $30,902.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.67 / $724.44 / $2,691.53
| Professional | | $44.67 | $724.44 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,125.38 / $26,302.68 / $37,153.52
| Facility | | $14,125.38 | $26,302.68 | $37,153.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,949.84 / $2,570.40
| Professional | | $1,659.59 | $1,949.84 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,344.23 / $2,630.27
| Professional | | $1,905.46 | $2,344.23 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,659.59 / $1,737.80
| Professional | | $1,412.54 | $1,659.59 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,344.23 / $3,548.13
| Professional | | $1,584.89 | $2,344.23 | $3,548.13 |