- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $2,818.38 / $4,897.79
| Facility | | $851.14 | $2,818.38 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $891.25 / $1,995.26
| Professional | | $269.15 | $891.25 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $954.99 / $8,709.64
| Facility | | $56.23 | $954.99 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $977.24 / $5,248.07
| Professional | | $281.84 | $977.24 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $302.00 / $707.95
| Facility | | $302.00 | $302.00 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $1,047.13 / $2,754.23
| Professional | | $302.00 | $1,047.13 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $707.95 / $2,818.38
| Professional | | $316.23 | $707.95 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $380.19 / $7,079.46
| Facility | | $177.83 | $380.19 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,698.24 / $3,019.95
| Professional | | $1,348.96 | $1,698.24 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,041.74 / $3,467.37
| Facility | | $630.96 | $2,041.74 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $1,122.02 / $2,754.23
| Professional | | $295.12 | $1,122.02 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,000.00 / $8,709.64
| Facility | | $56.23 | $1,000.00 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $977.24 / $5,248.07
| Professional | | $281.84 | $977.24 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,862.09 / $2,818.38
| Facility | | $501.19 | $1,862.09 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $1,000.00 / $2,754.23
| Professional | | $295.12 | $1,000.00 | $2,754.23 |