- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $492.73 / $10,087.00 / $11,986.00
| Facility | | $492.73 | $10,087.00 | $11,986.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $992.36 / $1,123.88 / $2,471.96
| Professional | | $992.36 | $1,123.88 | $2,471.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,725.95 / $2,998.55 / $5,088.43
| Facility | | $2,725.95 | $2,998.55 | $5,088.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,237.58 / $2,007.20 / $2,777.10
| Professional | | $1,237.58 | $2,007.20 | $2,777.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $825.38 / $3,390.19 / $5,654.79
| Facility | | $825.38 | $3,390.19 | $5,654.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,128.04 / $1,599.61 / $2,732.27
| Professional | | $1,128.04 | $1,599.61 | $2,732.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,035.03 / $1,331.79 / $1,966.81
| Facility | | $1,035.03 | $1,331.79 | $1,966.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $817.00 / $860.00 / $2,016.98
| Professional | | $817.00 | $860.00 | $2,016.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,104.09 / $1,327.30 / $2,246.50
| Professional | | $1,104.09 | $1,327.30 | $2,246.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,461.00 / $2,050.00 / $15,712.00
| Facility | | $1,461.00 | $2,050.00 | $15,712.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $934.09 / $1,252.99 / $2,671.59
| Professional | | $934.09 | $1,252.99 | $2,671.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,993.70 / $16,547.20 / $26,542.00
| Facility | | $6,993.70 | $16,547.20 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,430.60 / $11,430.60 / $11,430.60
| Professional | | $11,430.60 | $11,430.60 | $11,430.60 |