- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $3,388.44 / $10,471.29
| Facility | | $602.56 | $3,388.44 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $812.83 / $1,905.46
| Professional | | $616.60 | $812.83 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $794.33 / $812.83
| Professional | | $426.58 | $794.33 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $977.24 / $1,862.09
| Facility | | $489.78 | $977.24 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $831.76 / $1,380.38
| Professional | | $588.84 | $831.76 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $5,888.44 / $11,481.54
| Facility | | $3,235.94 | $5,888.44 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $676.08 / $1,000.00
| Professional | | $616.60 | $676.08 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $724.44 / $1,288.25
| Professional | | $32.36 | $724.44 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $3,548.13 / $6,760.83
| Facility | | $1,023.29 | $3,548.13 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $758.58 / $1,380.38
| Professional | | $549.54 | $758.58 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $549.54 / $676.08
| Professional | | $549.54 | $549.54 | $676.08 |