- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $5,128.61 / $16,218.10
| Facility | | $2,691.53 | $5,128.61 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $933.25 / $19,054.61
| Professional | | $933.25 | $933.25 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $11,220.18 / $63,095.73
| Facility | | $2,691.53 | $11,220.18 | $63,095.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $15,848.93 / $21,877.62
| Facility | | $7,762.47 | $15,848.93 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $6,918.31 / $35,481.34
| Facility | | $2,691.53 | $6,918.31 | $35,481.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,840.32 / $39,810.72 / $52,480.75
| Professional | | $28,840.32 | $39,810.72 | $52,480.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $11,220.18 / $63,095.73
| Facility | | $3,311.31 | $11,220.18 | $63,095.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $7,244.36 / $40,738.03
| Facility | | $2,691.53 | $7,244.36 | $40,738.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30,902.95 / $39,810.72 / $47,863.01
| Professional | | $30,902.95 | $39,810.72 | $47,863.01 |