- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $7,762.47 / $29,512.09
| Facility | | $1,737.80 | $7,762.47 | $29,512.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $912.01 / $9,549.93
| Professional | | $912.01 | $912.01 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $15,488.17 / $38,018.94
| Facility | | $6,025.60 | $15,488.17 | $38,018.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $3.98 / $3.98
| Professional | | $0.02 | $3.98 | $3.98 |
- 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
- $1,096.48 / $1,096.48 / $1,096.48
| Professional | | $1,096.48 | $1,096.48 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $14,791.08 / $41,686.94
| Facility | | $3,715.35 | $14,791.08 | $41,686.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,488.17 / $40,738.03 / $69,183.10
| Professional | | $15,488.17 | $40,738.03 | $69,183.10 |