- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,618.00 / $3,111.85 / $8,271.00
| Facility | | $2,618.00 | $3,111.85 | $8,271.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,116.64 / $1,224.76 / $1,684.50
| Professional | | $1,116.64 | $1,224.76 | $1,684.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,386.00 / $5,904.00 / $16,183.97
| Facility | | $2,386.00 | $5,904.00 | $16,183.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,161.49 / $2,216.37 / $9,000.00
| Professional | | $1,161.49 | $2,216.37 | $9,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,281.64 / $2,286.55 / $4,144.14
| Professional | | $1,281.64 | $2,286.55 | $4,144.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,754.07 / $8,090.00
| Facility | | $300.00 | $1,754.07 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.39 / $1,259.38 / $2,030.38
| Professional | | $676.39 | $1,259.38 | $2,030.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,378.30 / $2,748.88 / $4,024.33
| Professional | | $1,378.30 | $2,748.88 | $4,024.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.19 / $353.19 / $353.19
| Professional | | $353.19 | $353.19 | $353.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,386.00 / $7,247.10 / $15,421.00
| Facility | | $2,386.00 | $7,247.10 | $15,421.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,319.15 / $2,338.76 / $9,000.00
| Professional | | $1,319.15 | $2,338.76 | $9,000.00 |
- 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
- $1,269.94 / $1,675.34 / $3,808.04
| Professional | | $1,269.94 | $1,675.34 | $3,808.04 |