- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $750.58 / $750.58 / $11,395.25
| Facility | | $750.58 | $750.58 | $11,395.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $690.22 / $765.34 / $1,220.47
| Professional | | $690.22 | $765.34 | $1,220.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,229.92 / $11,253.87 / $25,424.06
| Facility | | $3,229.92 | $11,253.87 | $25,424.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,329.74 / $2,137.29 / $2,788.85
| Professional | | $1,329.74 | $2,137.29 | $2,788.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,828.45 / $2,594.31 / $6,240.97
| Facility | | $1,828.45 | $2,594.31 | $6,240.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,372.57 / $2,186.46 / $3,247.25
| Professional | | $1,372.57 | $2,186.46 | $3,247.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,662.23 / $2,371.82 / $4,914.14
| Facility | | $1,662.23 | $2,371.82 | $4,914.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,242.68 / $1,954.85 / $2,977.92
| Professional | | $1,242.68 | $1,954.85 | $2,977.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $771.34 / $1,312.85 / $3,552.10
| Facility | | $771.34 | $1,312.85 | $3,552.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $805.52 / $1,446.92 / $2,973.28
| Professional | | $805.52 | $1,446.92 | $2,973.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,121.00 / $5,499.00 / $9,810.00
| Facility | | $3,121.00 | $5,499.00 | $9,810.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $805.52 / $1,531.32 / $2,931.43
| Professional | | $805.52 | $1,531.32 | $2,931.43 |