- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $762.32 / $1,230.33 / $10,924.00
| Facility | | $762.32 | $1,230.33 | $10,924.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $762.32 / $762.32 / $1,317.85
| Professional | | $762.32 | $762.32 | $1,317.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,101.34 / $1,783.57 / $2,133.89
| Professional | | $1,101.34 | $1,783.57 | $2,133.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $905.28 / $1,282.46 / $2,109.26
| Professional | | $905.28 | $1,282.46 | $2,109.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $762.32 / $1,085.00 / $1,903.30
| Facility | | $762.32 | $1,085.00 | $1,903.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,026.45 / $1,026.45 / $1,026.45
| Professional | | $1,026.45 | $1,026.45 | $1,026.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,085.29 / $1,197.36 / $1,258.40
| Professional | | $1,085.29 | $1,197.36 | $1,258.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,172.00 / $4,086.00 / $7,778.00
| Facility | | $1,172.00 | $4,086.00 | $7,778.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $762.21 / $1,083.21 / $2,072.25
| Professional | | $762.21 | $1,083.21 | $2,072.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,543.52 / $11,933.00 / $14,017.76
| Facility | | $11,543.52 | $11,933.00 | $14,017.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,508.15 / $8,508.15 / $8,508.15
| Professional | | $8,508.15 | $8,508.15 | $8,508.15 |