- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,421.00 / $2,663.12 / $3,693.00
| Facility | | $1,421.00 | $2,663.12 | $3,693.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $583.87 / $680.64 / $1,065.89
| Professional | | $583.87 | $680.64 | $1,065.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,625.48 / $4,983.00 / $10,138.40
| Facility | | $1,625.48 | $4,983.00 | $10,138.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $603.98 / $939.32 / $5,000.08
| Professional | | $603.98 | $939.32 | $5,000.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $605.88 / $605.88 / $2,160.52
| Professional | | $605.88 | $605.88 | $2,160.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,082.51 / $2,082.51 / $2,082.51
| Facility | | $2,082.51 | $2,082.51 | $2,082.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $605.90 / $1,154.21 / $2,003.31
| Professional | | $605.90 | $1,154.21 | $2,003.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $695.26 / $1,524.80 / $6,679.00
| Facility | | $695.26 | $1,524.80 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $768.26 / $972.06 / $1,341.82
| Professional | | $768.26 | $972.06 | $1,341.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $845.82 / $1,703.48 / $5,944.58
| Professional | | $845.82 | $1,703.48 | $5,944.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $5,572.00 / $16,394.00
| Facility | | $2,155.00 | $5,572.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $637.24 / $955.92 / $5,000.08
| Professional | | $637.24 | $955.92 | $5,000.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $4,402.00 / $8,810.00
| Facility | | $2,155.00 | $4,402.00 | $8,810.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $611.29 / $884.27 / $1,998.96
| Professional | | $611.29 | $884.27 | $1,998.96 |