- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $4,897.79 / $11,748.98
| Facility | | $3,630.78 | $4,897.79 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $2,570.40 / $3,019.95
| Professional | | $478.63 | $2,570.40 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,162.28 / $9,549.93
| Facility | | $3,162.28 | $3,162.28 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.30 / $16.98 / $208.93
| Professional | | $12.30 | $16.98 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $45,708.82 / $69,183.10
| Facility | | $3,090.30 | $45,708.82 | $69,183.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,041.74 / $12,302.69
| Facility | | $2,041.74 | $2,041.74 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.38 / $3,890.45 / $9,549.93
| Professional | | $17.38 | $3,890.45 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,162.28 / $3,162.28
| Facility | | $3,162.28 | $3,162.28 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,905.46 / $3,162.28
| Professional | | $1,318.26 | $1,905.46 | $3,162.28 |