- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $2,587.52 / $9,859.00
| Facility | | $100.00 | $2,587.52 | $9,859.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,386.35 / $1,481.22 / $2,020.24
| Professional | | $1,386.35 | $1,481.22 | $2,020.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,302.10 / $3,669.21 / $6,000.00
| Facility | | $3,302.10 | $3,669.21 | $6,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,510.26 / $2,517.96 / $3,860.36
| Professional | | $1,510.26 | $2,517.96 | $3,860.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,736.96 / $2,862.32 / $2,962.50
| Facility | | $1,736.96 | $2,862.32 | $2,962.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,890.95 / $2,762.85 / $4,584.62
| Professional | | $1,890.95 | $2,762.85 | $4,584.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,728.93 / $2,836.48 / $5,336.34
| Professional | | $1,728.93 | $2,836.48 | $5,336.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,611.00 / $8,611.00 / $8,611.00
| Facility | | $8,611.00 | $8,611.00 | $8,611.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.51 / $2,331.94 / $4,577.45
| Professional | | $1,659.51 | $2,331.94 | $4,577.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.78 / $1,323.06 / $1,683.89
| Professional | | $1,202.78 | $1,323.06 | $1,683.89 |