- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $5,128.61 / $11,220.18
| Facility | | $363.08 | $5,128.61 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $489.78 / $831.76
| Professional | | $363.08 | $489.78 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $9,772.37 / $23,442.29
| Facility | | $3,019.95 | $9,772.37 | $23,442.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $851.14 / $1,380.38
| Professional | | $575.44 | $851.14 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,380.38 / $3,311.31
| Facility | | $977.24 | $1,380.38 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $794.33 / $794.33 / $794.33
| Facility | 22 | $794.33 | $794.33 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,174.90 / $1,778.28
| Professional | | $776.25 | $1,174.90 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,318.26 / $2,570.40
| Facility | | $1,071.52 | $1,318.26 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,000.00 / $1,513.56
| Professional | | $707.95 | $1,000.00 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $1,071.52 / $8,709.64
| Facility | | $512.86 | $1,071.52 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $794.33 / $1,737.80
| Professional | | $501.19 | $794.33 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $5,248.07 / $13,489.63
| Facility | | $2,884.03 | $5,248.07 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $794.33 / $1,513.56
| Professional | | $489.78 | $794.33 | $1,513.56 |