- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $467.74 / $6,025.60
| Facility | | $467.74 | $467.74 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $501.19 / $794.33
| Professional | | $426.58 | $501.19 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $6,918.31 / $14,454.40
| Facility | | $2,884.03 | $6,918.31 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,202.26 / $1,905.46
| Professional | | $812.83 | $1,202.26 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,905.46 / $4,570.88
| Facility | | $1,348.96 | $1,905.46 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,621.81 / $2,398.83
| Professional | | $1,047.13 | $1,621.81 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,819.70 / $3,548.13
| Facility | | $1,479.11 | $1,819.70 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,348.96 / $2,041.74
| Professional | | $977.24 | $1,348.96 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $1,047.13 / $7,762.47
| Facility | | $588.84 | $1,047.13 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $1,047.13 / $2,041.74
| Professional | | $588.84 | $1,047.13 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $5,248.07 / $8,912.51
| Facility | | $2,884.03 | $5,248.07 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $1,023.29 / $1,949.84
| Professional | | $588.84 | $1,023.29 | $1,949.84 |