- 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
- $120.25 / $530.60 / $3,261.23
| Professional | | $120.25 | $530.60 | $3,261.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.00 / $966.90 / $3,247.57
| Facility | | $308.00 | $966.90 | $3,247.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.08 / $2,789.58 / $7,191.27
| Professional | | $205.08 | $2,789.58 | $7,191.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $219.12 / $284.86 / $558.76
| Facility | | $219.12 | $284.86 | $558.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $307.20 / $1,218.07 / $3,997.31
| Professional | | $307.20 | $1,218.07 | $3,997.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $339.74 / $1,029.88 / $6,053.63
| Professional | | $339.74 | $1,029.88 | $6,053.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $189.59 / $299.66 / $6,679.00
| Facility | | $189.59 | $299.66 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,233.56 / $2,639.51 / $4,698.18
| Professional | | $2,233.56 | $2,639.51 | $4,698.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.03 / $796.90 / $4,821.18
| Professional | | $240.03 | $796.90 | $4,821.18 |
- 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
- $2,734.91 / $4,455.43 / $13,052.90
| Professional | | $2,734.91 | $4,455.43 | $13,052.90 |
- 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
- $2,421.91 / $3,249.49 / $7,191.27
| Professional | | $2,421.91 | $3,249.49 | $7,191.27 |