- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $3,548.13 / $8,709.64
| Facility | | $645.65 | $3,548.13 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $812.83 / $1,819.70
| Professional | | $602.56 | $812.83 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $660.69 / $1,122.02
| Professional | | $562.34 | $660.69 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $1,949.84 / $2,344.23
| Facility | | $436.52 | $1,949.84 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $812.83 / $1,348.96
| Professional | | $575.44 | $812.83 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $12,022.64 / $22,908.68
| Facility | | $6,165.95 | $12,022.64 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $691.83 / $1,000.00
| Professional | | $616.60 | $691.83 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $707.95 / $1,288.25
| Professional | | $32.36 | $707.95 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $7,585.78 / $12,022.64
| Facility | | $2,630.27 | $7,585.78 | $12,022.64 |
- 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
- $537.03 / $645.65 / $812.83
| Professional | | $537.03 | $645.65 | $812.83 |