- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $794.33 / $5,011.87
| Facility | | $794.33 | $794.33 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $831.76 / $1,348.96
| Professional | | $724.44 | $831.76 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $12,589.25 / $29,512.09
| Facility | | $4,897.79 | $12,589.25 | $29,512.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,949.84 / $3,019.95
| Professional | | $1,288.25 | $1,949.84 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,951.21 / $6,918.31
| Facility | | $2,089.30 | $2,951.21 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $2,398.83 / $3,548.13
| Professional | | $1,412.54 | $2,398.83 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,818.38 / $5,495.41
| Facility | | $2,238.72 | $2,818.38 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,995.26 / $3,162.28
| Professional | | $1,513.56 | $1,995.26 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,513.56 / $9,772.37
| Facility | | $831.76 | $1,513.56 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,548.82 / $4,466.84
| Professional | | $812.83 | $1,548.82 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $6,309.57 / $11,748.98
| Facility | | $3,235.94 | $6,309.57 | $11,748.98 |
- 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 |