- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $882.00 / $2,747.00 / $8,017.00
| Facility | | $882.00 | $2,747.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.95 / $1,000.00 / $1,590.95
| Professional | | $73.95 | $1,000.00 | $1,590.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,000.00 / $8,639.91 / $79,506.39
| Facility | | $5,000.00 | $8,639.91 | $79,506.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,765.31 / $5,402.39 / $5,606.25
| Professional | | $4,765.31 | $5,402.39 | $5,606.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.31 / $130.97 / $4,235.29
| Professional | | $109.31 | $130.97 | $4,235.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,720.63 / $8,640.81 / $8,917.61
| Professional | | $6,720.63 | $8,640.81 | $8,917.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,946.13 / $2,946.13 / $2,946.13
| Professional | | $2,946.13 | $2,946.13 | $2,946.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $934.00 / $3,120.00 / $8,017.00
| Facility | | $934.00 | $3,120.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.45 / $1,034.71 / $3,615.44
| Professional | | $71.45 | $1,034.71 | $3,615.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $160.91 / $160.91 / $160.91
| Facility | | $160.91 | $160.91 | $160.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.31 / $438.09 / $4,235.29
| Professional | | $109.31 | $438.09 | $4,235.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $92.13 / $105.09 / $2,967.99
| Facility | | $92.13 | $105.09 | $2,967.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.13 / $1,994.37 / $3,261.30
| Professional | | $92.13 | $1,994.37 | $3,261.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.00 / $674.00 / $4,300.00
| Facility | | $144.00 | $674.00 | $4,300.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,744.56 / $2,296.75 / $4,337.25
| Professional | | $1,744.56 | $2,296.75 | $4,337.25 |