- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $188.23 / $6,435.86 / $12,541.70
| Facility | | $188.23 | $6,435.86 | $12,541.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,128.02 / $4,128.02 / $4,540.82
| Professional | | $4,128.02 | $4,128.02 | $4,540.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,823.30 / $4,478.51 / $8,639.91
| Facility | | $3,823.30 | $4,478.51 | $8,639.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,283.79 / $4,283.79 / $4,283.79
| Professional | | $4,283.79 | $4,283.79 | $4,283.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,894.36 / $4,128.02 / $4,128.02
| Facility | | $3,894.36 | $4,128.02 | $4,128.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,128.02 / $4,128.02 / $4,283.79
| Professional | | $4,128.02 | $4,128.02 | $4,283.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,283.80 / $4,478.51 / $5,589.34
| Professional | | $4,283.80 | $4,478.51 | $5,589.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $523.71 / $523.71 / $675.02
| Facility | | $523.71 | $523.71 | $675.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $727.69 / $6,250.21 / $12,541.70
| Facility | | $727.69 | $6,250.21 | $12,541.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,128.02 / $4,166.81 / $7,041.91
| Professional | | $4,128.02 | $4,166.81 | $7,041.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.40 / $120.20 / $157.30
| Professional | | $27.40 | $120.20 | $157.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,894.36 / $4,128.02 / $4,128.02
| Facility | | $3,894.36 | $4,128.02 | $4,128.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,128.02 / $4,128.02 / $4,307.39
| Professional | | $4,128.02 | $4,128.02 | $4,307.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,890.17 / $2,890.17 / $3,353.69
| Facility | | $2,890.17 | $2,890.17 | $3,353.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,890.17 / $2,890.17 / $3,353.69
| Professional | | $2,890.17 | $2,890.17 | $3,353.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,128.02 / $4,375.70 / $5,387.07
| Professional | | $4,128.02 | $4,375.70 | $5,387.07 |