- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $67,608.30 / $89,125.09
| Facility | | $912.01 | $67,608.30 | $89,125.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,096.48 / $1,584.89
| Professional | | $891.25 | $1,096.48 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,380.38 / $2,398.83
| Professional | | $1,096.48 | $1,380.38 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,162.28 / $5,623.41
| Facility | | $2,398.83 | $3,162.28 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,148.15 / $3,715.35
| Professional | | $1,148.15 | $1,148.15 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $18,620.87 / $30,902.95
| Facility | | $1,071.52 | $18,620.87 | $30,902.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,659.59 / $3,019.95
| Professional | | $1,071.52 | $1,659.59 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,778.28 / $8,128.31
| Facility | | $1,047.13 | $1,778.28 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $2,290.87 / $17,378.01
| Professional | | $1,230.27 | $2,290.87 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $5,888.44 / $23,442.29
| Facility | | $5,623.41 | $5,888.44 | $23,442.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $2,187.76 / $3,715.35
| Professional | | $1,288.25 | $2,187.76 | $3,715.35 |