- 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
- $314.06 / $1,142.92 / $1,557.69
| Professional | | $314.06 | $1,142.92 | $1,557.69 |
- 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
- $1,056.64 / $1,096.51 / $1,096.51
| Professional | | $1,056.64 | $1,096.51 | $1,096.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.40 / $727.74 / $2,051.60
| Professional | | $346.40 | $727.74 | $2,051.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,736.86 / $1,736.86 / $1,771.76
| Professional | | $1,736.86 | $1,736.86 | $1,771.76 |
- 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
- $340.12 / $1,142.92 / $2,225.69
| Professional | | $340.12 | $1,142.92 | $2,225.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.27 / $996.83 / $2,631.62
| Professional | | $309.27 | $996.83 | $2,631.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.49 / $707.20 / $2,007.98
| Professional | | $350.49 | $707.20 | $2,007.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $270.02 / $319.19 / $1,108.97
| Facility | | $270.02 | $319.19 | $1,108.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.75 / $337.07 / $1,131.15
| Professional | | $306.75 | $337.07 | $1,131.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,304.00 / $4,584.00 / $9,631.00
| Facility | | $2,304.00 | $4,584.00 | $9,631.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.10 / $1,478.27 / $2,432.19
| Professional | | $1,047.10 | $1,478.27 | $2,432.19 |