- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,575.00 / $3,363.00 / $7,403.20
| Facility | | $2,575.00 | $3,363.00 | $7,403.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $434.17 / $505.95 / $1,234.81
| Professional | | $434.17 | $505.95 | $1,234.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,004.96 / $6,078.00 / $21,130.00
| Facility | | $1,004.96 | $6,078.00 | $21,130.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $401.33 / $842.16 / $3,152.08
| Professional | | $401.33 | $842.16 | $3,152.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $550.96 / $864.84 / $1,594.72
| Professional | | $550.96 | $864.84 | $1,594.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $428.88 / $918.40 / $6,679.00
| Facility | | $428.88 | $918.40 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.32 / $492.14 / $793.43
| Professional | | $264.32 | $492.14 | $793.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $532.89 / $1,062.80 / $1,544.51
| Professional | | $532.89 | $1,062.80 | $1,544.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,277.39 / $7,277.39 / $7,277.39
| Facility | | $7,277.39 | $7,277.39 | $7,277.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $653.29 / $653.29 / $653.29
| Professional | | $653.29 | $653.29 | $653.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,386.00 / $7,292.00 / $26,542.00
| Facility | | $2,386.00 | $7,292.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $485.65 / $945.13 / $3,152.08
| Professional | | $485.65 | $945.13 | $3,152.08 |
- 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
- $401.33 / $670.68 / $1,735.45
| Professional | | $401.33 | $670.68 | $1,735.45 |