- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $674.77 / $2,776.42 / $7,397.00
| Facility | | $674.77 | $2,776.42 | $7,397.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $674.77 / $2,597.21 / $4,167.54
| Professional | | $674.77 | $2,597.21 | $4,167.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,420.80 / $10,188.53 / $20,811.61
| Facility | | $3,420.80 | $10,188.53 | $20,811.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,334.87 / $3,717.86 / $8,815.37
| Professional | | $1,334.87 | $3,717.86 | $8,815.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,597.42 / $9,360.79 / $22,518.64
| Facility | | $6,597.42 | $9,360.79 | $22,518.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,459.26 / $3,480.66 / $10,742.02
| Professional | | $1,459.26 | $3,480.66 | $10,742.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,365.99 / $8,542.33 / $17,731.21
| Facility | | $5,365.99 | $8,542.33 | $17,731.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,444.82 / $3,796.47 / $8,981.74
| Professional | | $1,444.82 | $3,796.47 | $8,981.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $749.68 / $2,055.94 / $6,855.39
| Facility | | $749.68 | $2,055.94 | $6,855.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,006.87 / $6,072.12 / $11,768.74
| Professional | | $3,006.87 | $6,072.12 | $11,768.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,412.00 / $3,756.00 / $8,193.00
| Facility | | $2,412.00 | $3,756.00 | $8,193.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,831.71 / $5,724.73 / $10,655.41
| Professional | | $2,831.71 | $5,724.73 | $10,655.41 |