- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,969.85 / $9,838.43 / $20,725.80
| Facility | | $2,969.85 | $9,838.43 | $20,725.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $477.00 / $2,969.85 / $3,064.64
| Professional | | $477.00 | $2,969.85 | $3,064.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,317.39 / $5,055.07 / $11,057.97
| Facility | | $3,317.39 | $5,055.07 | $11,057.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,843.48 / $6,472.26 / $23,695.65
| Professional | | $2,843.48 | $6,472.26 | $23,695.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,285.79 / $6,715.95 / $8,158.01
| Facility | | $3,285.79 | $6,715.95 | $8,158.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,843.48 / $3,159.42 / $7,898.55
| Facility | | $2,843.48 | $3,159.42 | $7,898.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,843.48 / $3,159.42 / $7,898.55
| Professional | | $2,843.48 | $3,159.42 | $7,898.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.00 / $50.00 / $75.00
| Professional | | $45.00 | $50.00 | $75.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,843.48 / $3,475.36 / $5,528.99
| Facility | | $2,843.48 | $3,475.36 | $5,528.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,159.42 / $5,528.99 / $9,478.26
| Facility | | $3,159.42 | $5,528.99 | $9,478.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,843.48 / $3,949.28 / $4,770.72
| Professional | | $2,843.48 | $3,949.28 | $4,770.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,317.39 / $5,055.07 / $8,688.41
| Facility | | $3,317.39 | $5,055.07 | $8,688.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,494.32 / $6,148.65 / $7,346.03
| Professional | | $3,494.32 | $6,148.65 | $7,346.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,326.96 / $1,326.96 / $3,538.55
| Professional | | $1,326.96 | $1,326.96 | $3,538.55 |