- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $7,079.46 / $14,125.38
| Facility | | $794.33 | $7,079.46 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $954.99 / $3,715.35
| Professional | | $676.08 | $954.99 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $14,125.38 / $32,359.37
| Facility | | $4,466.84 | $14,125.38 | $32,359.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,862.09 / $2,884.03
| Professional | | $1,258.93 | $1,862.09 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,884.03 / $6,918.31
| Facility | | $2,041.74 | $2,884.03 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,344.23 / $3,467.37
| Professional | | $1,380.38 | $2,344.23 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,754.23 / $5,370.32
| Facility | | $2,238.72 | $2,754.23 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,949.84 / $3,162.28
| Professional | | $1,479.11 | $1,949.84 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,698.24 / $7,762.47
| Facility | | $851.14 | $1,698.24 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,513.56 / $4,365.16
| Professional | | $776.25 | $1,513.56 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $4,786.30 / $9,332.54
| Facility | | $2,398.83 | $4,786.30 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,380.38 / $2,754.23
| Professional | | $776.25 | $1,380.38 | $2,754.23 |