- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $988.00 / $2,079.00 / $3,625.00
| Facility | | $988.00 | $2,079.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.27 / $547.88 / $3,369.93
| Professional | | $126.27 | $547.88 | $3,369.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.00 / $966.90 / $2,796.00
| Facility | | $308.00 | $966.90 | $2,796.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.18 / $2,960.84 / $6,707.46
| Professional | | $211.18 | $2,960.84 | $6,707.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $226.78 / $294.81 / $578.29
| Facility | | $226.78 | $294.81 | $578.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $351.81 / $1,063.46 / $5,782.67
| Professional | | $351.81 | $1,063.46 | $5,782.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $196.19 / $304.56 / $6,679.00
| Facility | | $196.19 | $304.56 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,682.50 / $1,983.18 / $3,539.05
| Professional | | $1,682.50 | $1,983.18 | $3,539.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.63 / $1,397.16 / $3,640.84
| Professional | | $248.63 | $1,397.16 | $3,640.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,818.00 / $3,445.00
| Facility | | $55.00 | $1,818.00 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,564.28 / $4,895.27 / $12,542.72
| Professional | | $2,564.28 | $4,895.27 | $12,542.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,818.00 / $2,733.00
| Facility | | $627.00 | $1,818.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,302.16 / $4,166.56 / $9,856.86
| Professional | | $2,302.16 | $4,166.56 | $9,856.86 |