- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $812.83 / $8,317.64
| Facility | | $812.83 | $812.83 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $831.76 / $2,089.30
| Professional | | $724.44 | $831.76 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $14,125.38 / $32,359.37
| Facility | | $4,786.30 | $14,125.38 | $32,359.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,995.26 / $3,019.95
| Professional | | $1,318.26 | $1,995.26 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,019.95 / $7,079.46
| Facility | | $2,137.96 | $3,019.95 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,454.71 / $3,630.78
| Professional | | $1,445.44 | $2,454.71 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,884.03 / $5,623.41
| Facility | | $2,290.87 | $2,884.03 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,041.74 / $3,235.94
| Professional | | $1,548.82 | $2,041.74 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,584.89 / $6,760.83
| Facility | | $812.83 | $1,584.89 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,548.82 / $4,466.84
| Professional | | $758.58 | $1,548.82 | $4,466.84 |
- 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
- $794.33 / $1,445.44 / $2,884.03
| Professional | | $794.33 | $1,445.44 | $2,884.03 |