- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $562.34 / $5,011.87
| Facility | | $562.34 | $562.34 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $645.65 / $1,023.29
| Professional | | $549.54 | $645.65 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $7,413.10 / $14,454.40
| Facility | | $3,388.44 | $7,413.10 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,380.38 / $2,238.72
| Professional | | $933.25 | $1,380.38 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,238.72 / $5,370.32
| Facility | | $1,584.89 | $2,238.72 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,905.46 / $2,818.38
| Professional | | $1,230.27 | $1,905.46 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,137.96 / $4,168.69
| Facility | | $1,698.24 | $2,137.96 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,584.89 / $2,398.83
| Professional | | $1,148.15 | $1,584.89 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,230.27 / $7,762.47
| Facility | | $676.08 | $1,230.27 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $1,202.26 / $3,311.31
| Professional | | $676.08 | $1,202.26 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $5,248.07 / $8,912.51
| Facility | | $3,235.94 | $5,248.07 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $1,202.26 / $2,398.83
| Professional | | $676.08 | $1,202.26 | $2,398.83 |