- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,151.95 / $4,048.00 / $8,451.00
| Facility | | $1,151.95 | $4,048.00 | $8,451.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.81 / $1,151.95 / $1,369.52
| Professional | | $776.81 | $1,151.95 | $1,369.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,493.35 / $1,493.35 / $1,493.35
| Facility | | $1,493.35 | $1,493.35 | $1,493.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $705.23 / $775.06 / $5,843.53
| Professional | | $705.23 | $775.06 | $5,843.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $473.45 / $1,023.27 / $2,238.19
| Professional | | $473.45 | $1,023.27 | $2,238.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,151.00 / $4,993.00 / $10,247.00
| Facility | | $1,151.00 | $4,993.00 | $10,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.81 / $1,247.09 / $2,660.00
| Professional | | $776.81 | $1,247.09 | $2,660.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.00 / $8.00 / $8.00
| Professional | | $8.00 | $8.00 | $8.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,493.35 / $1,493.35 / $1,493.35
| Facility | | $1,493.35 | $1,493.35 | $1,493.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $705.23 / $775.06 / $5,843.53
| Professional | | $705.23 | $775.06 | $5,843.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,673.10 / $1,673.10 / $1,842.25
| Facility | | $1,673.10 | $1,673.10 | $1,842.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $601.04 / $1,706.56 / $1,842.25
| Professional | | $601.04 | $1,706.56 | $1,842.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $3,475.00 / $6,368.00
| Facility | | $2,155.00 | $3,475.00 | $6,368.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,405.97 / $2,098.80 / $3,245.48
| Professional | | $1,405.97 | $2,098.80 | $3,245.48 |