- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $768.00 / $3,627.00 / $8,017.00
| Facility | | $768.00 | $3,627.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $366.90 / $1,266.14 / $1,778.04
| Professional | | $366.90 | $1,266.14 | $1,778.04 |
- 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
- $1,041.13 / $2,020.17 / $3,287.95
| Professional | | $1,041.13 | $2,020.17 | $3,287.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $387.90 / $785.41 / $2,544.04
| Professional | | $387.90 | $785.41 | $2,544.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,935.03 / $1,935.03 / $1,963.33
| Professional | | $1,935.03 | $1,935.03 | $1,963.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.00 / $3,964.00 / $8,017.00
| Facility | | $954.00 | $3,964.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $366.90 / $1,266.14 / $2,850.21
| Professional | | $366.90 | $1,266.14 | $2,850.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $3,394.80 / $4,116.20
| Professional | | $5.00 | $3,394.80 | $4,116.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $401.88 / $800.77 / $2,522.75
| Professional | | $401.88 | $800.77 | $2,522.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.35 / $344.17 / $1,549.64
| Facility | | $331.35 | $344.17 | $1,549.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.35 / $344.58 / $1,333.65
| Professional | | $331.35 | $344.58 | $1,333.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $3,475.00 / $6,000.00
| Facility | | $2,155.00 | $3,475.00 | $6,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,312.36 / $1,939.83 / $2,933.80
| Professional | | $1,312.36 | $1,939.83 | $2,933.80 |