- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $912.01 / $8,511.38
| Facility | | $891.25 | $912.01 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $891.25 / $1,258.93
| Professional | | $676.08 | $891.25 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,041.74 / $2,398.83
| Professional | | $1,659.59 | $2,041.74 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,905.46 / $2,884.03
| Professional | | $1,380.38 | $1,905.46 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,148.15 / $1,548.82
| Facility | | $912.01 | $1,148.15 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,584.89 / $6,918.31
| Professional | | $870.96 | $1,584.89 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $5,128.61 / $5,128.61
| Facility | | $4,677.35 | $5,128.61 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,479.11 / $2,344.23
| Professional | | $870.96 | $1,479.11 | $2,344.23 |