- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $7,413.10 / $15,848.93
| Facility | | $1,047.13 | $7,413.10 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $5,248.07 / $16,595.87
| Professional | | $645.65 | $5,248.07 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $1,023.29 / $13,803.84
| Professional | | $676.08 | $1,023.29 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $6,025.60 / $16,595.87
| Professional | | $1,096.48 | $6,025.60 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $2,290.87 / $13,803.84
| Professional | | $870.96 | $2,290.87 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $5,011.87 / $11,220.18
| Facility | | $645.65 | $5,011.87 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $21,379.62 / $28,840.32
| Facility | | $9,120.11 | $21,379.62 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $5,754.40 / $12,882.50
| Professional | | $724.44 | $5,754.40 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $52,480.75 / $52,480.75
| Facility | | $56.23 | $52,480.75 | $52,480.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44,668.36 / $52,480.75 / $52,480.75
| Professional | | $44,668.36 | $52,480.75 | $52,480.75 |