- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $428.00 / $2,482.51 / $8,017.00
| Facility | | $428.00 | $2,482.51 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.26 / $1,042.51 / $2,609.39
| Professional | | $179.26 | $1,042.51 | $2,609.39 |
- 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
- $1,498.90 / $2,906.63 / $3,419.56
| Professional | | $1,498.90 | $2,906.63 | $3,419.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.94 / $457.16 / $3,389.38
| Professional | | $203.94 | $457.16 | $3,389.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,789.05 / $2,789.05 / $2,895.88
| Professional | | $2,789.05 | $2,789.05 | $2,895.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.00 / $2,420.67 / $7,799.00
| Facility | | $490.00 | $2,420.67 | $7,799.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.58 / $1,234.00 / $3,261.23
| Professional | | $186.58 | $1,234.00 | $3,261.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.70 / $1,603.10 / $3,206.20
| Professional | | $192.70 | $1,603.10 | $3,206.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.13 / $457.16 / $3,120.96
| Professional | | $206.13 | $457.16 | $3,120.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.03 / $200.29 / $2,048.54
| Facility | | $194.03 | $200.29 | $2,048.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.03 / $201.60 / $2,004.70
| Professional | | $194.03 | $201.60 | $2,004.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.00 / $650.00 / $3,742.00
| Facility | | $144.00 | $650.00 | $3,742.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,824.37 / $2,317.55 / $3,813.06
| Professional | | $1,824.37 | $2,317.55 | $3,813.06 |