- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $783.16 / $783.16 / $1,860.34
| Facility | | $783.16 | $783.16 | $1,860.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $669.26 / $816.22 / $1,099.17
| Professional | | $669.26 | $816.22 | $1,099.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,649.12 / $2,308.77 / $6,052.27
| Facility | | $1,649.12 | $2,308.77 | $6,052.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $770.62 / $1,371.22 / $2,632.74
| Professional | | $770.62 | $1,371.22 | $2,632.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,073.83 / $1,401.75 / $3,050.87
| Facility | | $1,073.83 | $1,401.75 | $3,050.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,401.75 / $1,401.75 / $1,401.75
| Professional | | $1,401.75 | $1,401.75 | $1,401.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,014.49 / $1,014.49 / $1,014.49
| Facility | | $1,014.49 | $1,014.49 | $1,014.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $740.58 / $740.58 / $1,688.19
| Professional | | $740.58 | $740.58 | $1,688.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,253.33 / $1,649.12 / $2,586.64
| Professional | | $1,253.33 | $1,649.12 | $2,586.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $925.15 / $2,038.86 / $3,050.87
| Professional | | $925.15 | $2,038.86 | $3,050.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $548.49 / $774.44 / $1,357.38
| Professional | | $548.49 | $774.44 | $1,357.38 |