- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $2,754.23 / $11,481.54
| Facility | | $2,398.83 | $2,754.23 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $512.86 / $4,786.30
| Professional | | $323.59 | $512.86 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $15,488.17 / $19,952.62
| Facility | | $9,332.54 | $15,488.17 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $891.25 / $7,585.78
| Professional | | $269.15 | $891.25 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $407.38 / $1,318.26 / $11,220.18
| Professional | 50 | $407.38 | $1,318.26 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $5,128.61 / $10,715.19
| Professional | | $616.60 | $5,128.61 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $12,589.25 / $12,589.25
| Facility | | $12,589.25 | $12,589.25 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $3,630.78 / $8,709.64
| Professional | | $323.59 | $3,630.78 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $12,589.25 / $12,589.25
| Facility | | $12,589.25 | $12,589.25 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $3,630.78 / $10,964.78
| Professional | | $446.68 | $3,630.78 | $10,964.78 |