- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $912.01 / $5,011.87
| Facility | | $912.01 | $912.01 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $933.25 / $1,479.11
| Professional | | $812.83 | $933.25 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $14,125.38 / $32,359.37
| Facility | | $5,495.41 | $14,125.38 | $32,359.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,187.76 / $3,388.44
| Professional | | $1,479.11 | $2,187.76 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,311.31 / $7,943.28
| Facility | | $2,344.23 | $3,311.31 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,691.53 / $3,981.07
| Professional | | $1,584.89 | $2,691.53 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,162.28 / $6,165.95
| Facility | | $2,570.40 | $3,162.28 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,238.72 / $3,630.78
| Professional | | $1,698.24 | $2,238.72 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $1,778.28 / $10,715.19
| Facility | | $933.25 | $1,778.28 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,737.80 / $5,011.87
| Professional | | $912.01 | $1,737.80 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $9,332.54 / $13,182.57
| Facility | | $4,570.88 | $9,332.54 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,621.81 / $3,235.94
| Professional | | $933.25 | $1,621.81 | $3,235.94 |