- 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
- $162.76 / $1,000.28 / $2,200.64
| Professional | | $162.76 | $1,000.28 | $2,200.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $258.10 / $941.10 / $2,796.00
| Facility | | $258.10 | $941.10 | $2,796.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $247.33 / $1,910.91 / $5,735.08
| Professional | | $247.33 | $1,910.91 | $5,735.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $266.06 / $345.88 / $678.45
| Facility | | $266.06 | $345.88 | $678.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $411.80 / $1,250.15 / $4,113.96
| Professional | | $411.80 | $1,250.15 | $4,113.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $214.32 / $345.55 / $6,679.00
| Facility | | $214.32 | $345.55 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,409.52 / $1,661.16 / $2,970.05
| Professional | | $1,409.52 | $1,661.16 | $2,970.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.27 / $1,178.18 / $3,070.19
| Professional | | $293.27 | $1,178.18 | $3,070.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.83 / $362.83 / $381.48
| Professional | | $362.83 | $362.83 | $381.48 |
- 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
- $1,897.79 / $3,505.65 / $11,157.78
| Professional | | $1,897.79 | $3,505.65 | $11,157.78 |
- 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
- $1,599.99 / $2,613.30 / $4,709.68
| Professional | | $1,599.99 | $2,613.30 | $4,709.68 |