- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $812.83 / $7,079.46
| Facility | | $812.83 | $812.83 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $831.76 / $1,288.25
| Professional | | $724.44 | $831.76 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $35,481.34 / $83,176.38
| Facility | | $4,786.30 | $35,481.34 | $83,176.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,949.84 / $2,951.21
| Professional | | $1,318.26 | $1,949.84 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,951.21 / $7,079.46
| Facility | | $2,089.30 | $2,951.21 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,398.83 / $3,548.13
| Professional | | $1,445.44 | $2,398.83 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,818.38 / $5,495.41
| Facility | | $2,290.87 | $2,818.38 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,995.26 / $3,235.94
| Professional | | $1,513.56 | $1,995.26 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,584.89 / $12,022.64
| Facility | | $831.76 | $1,584.89 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,513.56 / $4,466.84
| Professional | | $758.58 | $1,513.56 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $11,481.54 / $28,183.83
| Facility | | $4,786.30 | $11,481.54 | $28,183.83 |
- 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 |