- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,466.00 / $9,245.00 / $14,482.00
| Facility | | $8,466.00 | $9,245.00 | $14,482.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.32 / $4,935.25 / $8,147.06
| Professional | | $251.32 | $4,935.25 | $8,147.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,084.00 / $11,290.00 / $18,458.00
| Facility | | $7,084.00 | $11,290.00 | $18,458.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,485.14 / $3,485.14 / $3,485.14
| Professional | | $3,485.14 | $3,485.14 | $3,485.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,204.16 / $4,204.16 / $4,204.16
| Facility | | $4,204.16 | $4,204.16 | $4,204.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,204.16 / $9,963.00 / $15,743.00
| Facility | | $4,204.16 | $9,963.00 | $15,743.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,485.14 / $3,485.14 / $3,485.14
| Professional | | $3,485.14 | $3,485.14 | $3,485.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.00 / $65.00 / $85.00
| Professional | | $50.00 | $65.00 | $85.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,204.16 / $4,204.16 / $4,204.16
| Facility | | $4,204.16 | $4,204.16 | $4,204.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,716.30 / $3,716.30 / $3,716.30
| Facility | | $3,716.30 | $3,716.30 | $3,716.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,485.14 / $3,485.14 / $3,485.14
| Professional | | $3,485.14 | $3,485.14 | $3,485.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,797.56 / $3,797.56 / $3,797.56
| Professional | | $3,797.56 | $3,797.56 | $3,797.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,301.00 / $11,799.00 / $13,980.00
| Facility | | $7,301.00 | $11,799.00 | $13,980.00 |