- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $484.56 / $3,891.70 / $7,920.26
| Facility | | $484.56 | $3,891.70 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,784.03 / $2,381.23 / $9,350.04
| Professional | | $1,784.03 | $2,381.23 | $9,350.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,411.94 / $3,961.55 / $5,325.98
| Professional | | $2,411.94 | $3,961.55 | $5,325.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,821.02 / $4,004.99 / $4,559.14
| Professional | | $2,821.02 | $4,004.99 | $4,559.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,381.23 / $3,550.45 / $5,140.78
| Facility | | $2,381.23 | $3,550.45 | $5,140.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,899.15 / $3,656.13 / $5,763.16
| Professional | | $2,899.15 | $3,656.13 | $5,763.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,587.71 / $3,436.51 / $3,659.76
| Facility | | $2,587.71 | $3,436.51 | $3,659.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,381.23 / $3,941.77 / $5,119.64
| Facility | | $2,381.23 | $3,941.77 | $5,119.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,108.22 / $4,197.96 / $5,530.01
| Professional | | $3,108.22 | $4,197.96 | $5,530.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,522.15 / $9,522.15 / $9,522.15
| Facility | | $9,522.15 | $9,522.15 | $9,522.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,313.78 / $4,359.43 / $5,742.53
| Professional | | $3,313.78 | $4,359.43 | $5,742.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,446.00 / $10,234.00 / $36,803.00
| Facility | | $2,446.00 | $10,234.00 | $36,803.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,758.08 / $3,833.28 / $5,732.28
| Professional | | $2,758.08 | $3,833.28 | $5,732.28 |