- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $4,265.80 / $15,488.17
| Facility | | $1,230.27 | $4,265.80 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $831.76 / $1,380.38
| Professional | | $691.83 | $831.76 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $660.69 / $831.76
| Professional | | $660.69 | $660.69 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $10,964.78 / $17,782.79
| Facility | | $6,918.31 | $10,964.78 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $870.96 / $1,122.02
| Professional | | $707.95 | $870.96 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,023.29 / $1,318.26
| Professional | | $776.25 | $1,023.29 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,981.07 / $10,715.19
| Facility | | $851.14 | $3,981.07 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $10,964.78 / $10,964.78 / $10,964.78
| Facility | 52 | $10,964.78 | $10,964.78 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $912.01 / $5,370.32
| Professional | | $660.69 | $912.01 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $5,754.40 / $10,715.19
| Facility | | $1,621.81 | $5,754.40 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $831.76 / $1,202.26
| Professional | | $630.96 | $831.76 | $1,202.26 |