- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $768.00 / $3,623.00 / $7,799.00
| Facility | | $768.00 | $3,623.00 | $7,799.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $333.23 / $1,182.40 / $1,935.43
| Professional | | $333.23 | $1,182.40 | $1,935.43 |
- 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
- $1,171.90 / $1,605.75 / $2,340.84
| Professional | | $1,171.90 | $1,605.75 | $2,340.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.64 / $736.71 / $2,353.31
| Professional | | $330.64 | $736.71 | $2,353.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,186.11 / $2,186.11 / $2,241.32
| Professional | | $2,186.11 | $2,186.11 | $2,241.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.00 / $3,839.00 / $8,017.00
| Facility | | $954.00 | $3,839.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.14 / $1,307.33 / $2,472.76
| Professional | | $336.14 | $1,307.33 | $2,472.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.00 / $2,312.00 / $4,191.10
| Professional | | $4.00 | $2,312.00 | $4,191.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.00 / $710.07 / $2,353.31
| Professional | | $340.00 | $710.07 | $2,353.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.12 / $1,097.07 / $1,691.55
| Facility | | $323.12 | $1,097.07 | $1,691.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.12 / $1,097.07 / $1,530.05
| Professional | | $323.12 | $1,097.07 | $1,530.05 |
- 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
- $1,273.42 / $1,726.74 / $2,850.48
| Professional | | $1,273.42 | $1,726.74 | $2,850.48 |