- 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
- $741.31 / $851.14 / $1,318.26
| Professional | | $741.31 | $851.14 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $24,547.09 / $58,884.37
| Facility | | $4,897.79 | $24,547.09 | $58,884.37 |
- 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
- $2,089.30 / $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 / $3,630.78
| Professional | | $1,445.44 | $2,398.83 | $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
- $851.14 / $1,584.89 / $9,772.37
| Facility | | $851.14 | $1,584.89 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,513.56 / $4,466.84
| Professional | | $776.25 | $1,513.56 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $6,309.57 / $12,589.25
| Facility | | $3,235.94 | $6,309.57 | $12,589.25 |
- 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 |