- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $5,888.44 / $8,511.38
| Facility | | $812.83 | $5,888.44 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $954.99 / $1,995.26
| Professional | | $812.83 | $954.99 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $1,202.26 / $1,548.82
| Professional | | $630.96 | $1,202.26 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $676.08
| Professional | | $32.36 | $33.11 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $6,456.54 / $14,791.08
| Facility | | $5,495.41 | $6,456.54 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,548.82 / $1,698.24
| Professional | | $1,202.26 | $1,548.82 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,412.54 / $1,737.80
| Professional | | $812.83 | $1,412.54 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,380.38 / $2,089.30
| Professional | | $1,000.00 | $1,380.38 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,128.61 / $8,317.64
| Facility | | $2,137.96 | $5,128.61 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $851.14 / $1,380.38
| Professional | | $676.08 | $851.14 | $1,380.38 |