- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,575.00 / $3,363.00 / $7,791.00
| Facility | | $2,575.00 | $3,363.00 | $7,791.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $764.27 / $1,004.99 / $2,430.21
| Professional | | $764.27 | $1,004.99 | $2,430.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,697.00 / $5,904.00 / $14,018.00
| Facility | | $1,697.00 | $5,904.00 | $14,018.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $700.92 / $1,487.35 / $5,504.40
| Professional | | $700.92 | $1,487.35 | $5,504.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.64 / $1,525.80 / $2,765.36
| Professional | | $870.64 | $1,525.80 | $2,765.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $745.19 / $1,587.32 / $6,679.00
| Facility | | $745.19 | $1,587.32 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $459.26 / $868.15 / $1,378.60
| Professional | | $459.26 | $868.15 | $1,378.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $929.79 / $1,854.37 / $2,692.44
| Professional | | $929.79 | $1,854.37 | $2,692.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,638.92 / $5,638.92 / $5,638.92
| Facility | | $5,638.92 | $5,638.92 | $5,638.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,211.07 / $1,211.07 / $1,211.07
| Professional | | $1,211.07 | $1,211.07 | $1,211.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,386.00 / $6,883.00 / $15,421.00
| Facility | | $2,386.00 | $6,883.00 | $15,421.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $853.31 / $1,669.21 / $5,504.40
| Professional | | $853.31 | $1,669.21 | $5,504.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,386.00 / $5,904.00 / $13,017.00
| Facility | | $2,386.00 | $5,904.00 | $13,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $767.62 / $1,212.99 / $3,064.18
| Professional | | $767.62 | $1,212.99 | $3,064.18 |