- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $433.43 / $5,034.50 / $25,223.21
| Facility | | $433.43 | $5,034.50 | $25,223.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $427.14 / $2,451.31 / $7,423.14
| Professional | | $427.14 | $2,451.31 | $7,423.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $820.59 / $1,061.98 / $10,039.24
| Professional | | $820.59 | $1,061.98 | $10,039.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.13 / $1,229.98 / $13,912.75
| Professional | | $588.13 | $1,229.98 | $13,912.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $433.43 / $5,034.50 / $15,103.50
| Facility | | $433.43 | $5,034.50 | $15,103.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,059.39 / $9,235.79 / $13,254.16
| Professional | | $5,059.39 | $9,235.79 | $13,254.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,147.22 / $9,588.58 / $13,254.16
| Professional | | $5,147.22 | $9,588.58 | $13,254.16 |