- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $832.00 / $3,627.00 / $8,017.00
| Facility | | $832.00 | $3,627.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $373.58 / $1,140.30 / $1,671.10
| Professional | | $373.58 | $1,140.30 | $1,671.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,431.95 / $7,827.00 / $19,139.18
| Facility | | $6,431.95 | $7,827.00 | $19,139.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,004.88 / $1,351.70 / $2,295.71
| Professional | | $1,004.88 | $1,351.70 | $2,295.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $378.52 / $846.10 / $2,105.87
| Professional | | $378.52 | $846.10 | $2,105.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,871.49 / $1,871.49 / $1,903.50
| Professional | | $1,871.49 | $1,871.49 | $1,903.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,832.68 / $6,832.68 / $14,108.09
| Facility | | $6,832.68 | $6,832.68 | $14,108.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,013.00 / $4,068.00 / $8,017.00
| Facility | | $1,013.00 | $4,068.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $383.79 / $1,140.30 / $2,075.35
| Professional | | $383.79 | $1,140.30 | $2,075.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $360.49 / $1,205.28 / $2,501.54
| Professional | | $360.49 | $1,205.28 | $2,501.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $404.20 / $814.42 / $2,087.50
| Professional | | $404.20 | $814.42 | $2,087.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $373.38 / $953.59 / $3,316.27
| Facility | | $373.38 | $953.59 | $3,316.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $373.38 / $953.59 / $1,296.67
| Professional | | $373.38 | $953.59 | $1,296.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,440.00 / $3,475.00 / $6,000.00
| Facility | | $1,440.00 | $3,475.00 | $6,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,159.26 / $1,637.09 / $2,398.32
| Professional | | $1,159.26 | $1,637.09 | $2,398.32 |