- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $358.81 / $1,715.13 / $5,480.00
| Facility | | $358.81 | $1,715.13 | $5,480.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.95 / $1,566.47 / $2,321.30
| Professional | | $335.95 | $1,566.47 | $2,321.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,124.92 / $8,365.08 / $17,252.16
| Facility | | $4,124.92 | $8,365.08 | $17,252.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $606.17 / $2,034.56 / $4,914.35
| Professional | | $606.17 | $2,034.56 | $4,914.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,719.44 / $5,274.63 / $12,688.82
| Facility | | $3,719.44 | $5,274.63 | $12,688.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $745.19 / $2,238.23 / $6,179.38
| Professional | | $745.19 | $2,238.23 | $6,179.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,928.69 / $4,822.27 / $9,991.20
| Facility | | $2,928.69 | $4,822.27 | $9,991.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $688.94 / $2,216.07 / $5,005.39
| Professional | | $688.94 | $2,216.07 | $5,005.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $566.66 / $2,986.65 / $8,153.86
| Facility | | $566.66 | $2,986.65 | $8,153.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,017.44 / $3,826.22 / $6,824.45
| Professional | | $2,017.44 | $3,826.22 | $6,824.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,991.00 / $8,153.86 / $10,412.94
| Facility | | $3,991.00 | $8,153.86 | $10,412.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,977.28 / $4,020.77 / $6,516.25
| Professional | | $1,977.28 | $4,020.77 | $6,516.25 |