- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $3,890.45 / $8,912.51
| Facility | | $724.44 | $3,890.45 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $912.01 / $2,884.03
| Professional | | $602.56 | $912.01 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $5,754.40 / $12,589.25
| Facility | | $1,778.28 | $5,754.40 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,513.56 / $2,398.83
| Professional | | $1,047.13 | $1,513.56 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,511.89 / $6,025.60
| Facility | | $1,778.28 | $2,511.89 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $1,318.26 / $1,318.26 / $1,318.26
| Facility | 22 | $1,318.26 | $1,318.26 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,137.96 / $3,162.28
| Professional | | $1,380.38 | $2,137.96 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,398.83 / $4,677.35
| Facility | | $1,949.84 | $2,398.83 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,778.28 / $2,691.53
| Professional | | $1,288.25 | $1,778.28 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $2,187.76 / $6,025.60
| Facility | | $758.58 | $2,187.76 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,348.96 / $3,630.78
| Professional | | $724.44 | $1,348.96 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $5,248.07 / $8,912.51
| Facility | | $2,884.03 | $5,248.07 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,348.96 / $2,630.27
| Professional | | $724.44 | $1,348.96 | $2,630.27 |