- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $477.00 / $1,554.59 / $4,030.65
| Facility | | $477.00 | $1,554.59 | $4,030.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $477.00 / $477.00 / $2,685.51
| Professional | | $477.00 | $477.00 | $2,685.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $244.00 / $614.00 / $15,828.69
| Facility | | $244.00 | $614.00 | $15,828.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,296.00 / $1,490.40 / $2,443.34
| Professional | | $1,296.00 | $1,490.40 | $2,443.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,437.53 / $2,053.62 / $5,135.08
| Professional | | $1,437.53 | $2,053.62 | $5,135.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,084.42 / $5,298.34 / $10,576.14
| Facility | | $2,084.42 | $5,298.34 | $10,576.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,527.54 / $3,159.42 / $4,265.22
| Professional | | $2,527.54 | $3,159.42 | $4,265.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,843.48 / $3,633.33 / $6,034.49
| Professional | | $2,843.48 | $3,633.33 | $6,034.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,497.39 / $15,007.25 / $15,007.25
| Facility | | $5,497.39 | $15,007.25 | $15,007.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,733.91 / $15,733.91 / $23,695.65
| Professional | | $15,733.91 | $15,733.91 | $23,695.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,053.62 / $3,791.30 / $8,382.87
| Facility | | $2,053.62 | $3,791.30 | $8,382.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,159.42 / $3,475.36 / $4,739.13
| Professional | | $3,159.42 | $3,475.36 | $4,739.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,527.54 / $2,843.48 / $4,296.82
| Professional | | $2,527.54 | $2,843.48 | $4,296.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,326.96 / $1,380.57 / $7,607.57
| Professional | | $1,326.96 | $1,380.57 | $7,607.57 |