- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $5,370.32 / $7,943.28
| Facility | | $524.81 | $5,370.32 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $549.54 / $1,949.84
| Professional | | $512.86 | $549.54 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $1,230.27 / $2,691.53
| Professional | | $645.65 | $1,230.27 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $151.36 / $151.36
| Professional | | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $5,370.32 / $8,709.64
| Facility | | $870.96 | $5,370.32 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,818.38 / $7,079.46
| Professional | | $1,698.24 | $2,818.38 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $1,230.27 / $2,691.53
| Professional | | $645.65 | $1,230.27 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $6,309.57 / $8,912.51
| Facility | | $4,265.80 | $6,309.57 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,951.21 / $5,754.40
| Professional | | $1,949.84 | $2,951.21 | $5,754.40 |