- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $577.60 / $2,747.00 / $5,454.00
| Facility | | $577.60 | $2,747.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $577.60 / $577.60 / $935.34
| Professional | | $577.60 | $577.60 | $935.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.00 / $5,716.26 / $16,742.00
| Facility | | $2,324.00 | $5,716.26 | $16,742.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $983.37 / $1,695.58 / $7,329.36
| Professional | | $983.37 | $1,695.58 | $7,329.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,079.43 / $1,079.43 / $2,643.41
| Professional | | $1,079.43 | $1,079.43 | $2,643.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,873.51 / $3,873.51 / $3,873.51
| Facility | | $3,873.51 | $3,873.51 | $3,873.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,382.63 / $1,382.63 / $1,626.62
| Professional | | $1,382.63 | $1,382.63 | $1,626.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,193.57 / $2,396.92 / $2,972.71
| Professional | | $1,193.57 | $2,396.92 | $2,972.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.00 / $5,716.26 / $16,742.00
| Facility | | $2,324.00 | $5,716.26 | $16,742.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $983.37 / $1,695.58 / $7,329.36
| Professional | | $983.37 | $1,695.58 | $7,329.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,365.00 / $5,097.00 / $12,850.00
| Facility | | $2,365.00 | $5,097.00 | $12,850.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $983.37 / $1,473.51 / $2,902.28
| Professional | | $983.37 | $1,473.51 | $2,902.28 |