- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $11,481.54 / $33,884.42
| Facility | | $1,819.70 | $11,481.54 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $676.08 / $10,232.93
| Professional | | $676.08 | $676.08 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $15,848.93 / $40,738.03
| Facility | | $5,888.44 | $15,848.93 | $40,738.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.03 / $8,511.38 / $8,511.38
| Professional | | $0.03 | $8,511.38 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $18,620.87 / $43,651.58
| Facility | | $8,128.31 | $18,620.87 | $43,651.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $363.08 / $363.08
| Professional | | $363.08 | $363.08 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $13,803.84 / $38,904.51
| Facility | | $3,715.35 | $13,803.84 | $38,904.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19,498.45 / $29,512.09 / $43,651.58
| Professional | | $19,498.45 | $29,512.09 | $43,651.58 |