- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $831.76 / $8,511.38
| Facility | | $812.83 | $831.76 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $812.83 / $2,089.30
| Professional | | $741.31 | $812.83 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,819.70 / $2,187.76
| Professional | | $1,479.11 | $1,819.70 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,584.89 / $2,570.40
| Professional | | $912.01 | $1,584.89 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,122.02 / $2,454.71
| Facility | | $812.83 | $1,122.02 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,445.44 / $6,606.93
| Professional | | $870.96 | $1,445.44 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,715.19 / $12,022.64 / $24,547.09
| Facility | | $10,715.19 | $12,022.64 | $24,547.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,445.44 / $1,995.26
| Professional | | $870.96 | $1,445.44 | $1,995.26 |