- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $634.79 / $2,832.00 / $14,899.96
| Facility | | $634.79 | $2,832.00 | $14,899.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,297.78 / $1,732.90 / $6,785.05
| Professional | | $1,297.78 | $1,732.90 | $6,785.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,746.03 / $2,787.82 / $3,874.51
| Professional | | $1,746.03 | $2,787.82 | $3,874.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,060.71 / $2,936.00 / $3,342.25
| Professional | | $2,060.71 | $2,936.00 | $3,342.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,732.90 / $2,593.55 / $3,725.74
| Facility | | $1,732.90 | $2,593.55 | $3,725.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,113.52 / $2,496.73 / $4,201.42
| Professional | | $2,113.52 | $2,496.73 | $4,201.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,870.65 / $2,510.31 / $2,653.36
| Facility | | $1,870.65 | $2,510.31 | $2,653.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,732.90 / $2,843.74 / $3,572.82
| Facility | | $1,732.90 | $2,843.74 | $3,572.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,253.98 / $3,043.56 / $4,009.31
| Professional | | $2,253.98 | $3,043.56 | $4,009.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,885.20 / $6,885.20 / $6,885.20
| Facility | | $6,885.20 | $6,885.20 | $6,885.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,407.84 / $3,167.63 / $4,172.60
| Professional | | $2,407.84 | $3,167.63 | $4,172.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,364.00 / $7,664.00 / $36,803.00
| Facility | | $2,364.00 | $7,664.00 | $36,803.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,954.82 / $2,924.48 / $4,165.14
| Professional | | $1,954.82 | $2,924.48 | $4,165.14 |