- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $988.00 / $2,094.00 / $3,685.00
| Facility | | $988.00 | $2,094.00 | $3,685.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.41 / $1,495.24 / $3,311.43
| Professional | | $98.41 | $1,495.24 | $3,311.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $317.25 / $2,089.00 / $9,012.00
| Facility | | $317.25 | $2,089.00 | $9,012.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.25 / $2,347.46 / $6,069.23
| Professional | | $153.25 | $2,347.46 | $6,069.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $164.93 / $214.41 / $420.57
| Facility | | $164.93 | $214.41 | $420.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.23 / $2,039.08 / $3,659.94
| Professional | | $231.23 | $2,039.08 | $3,659.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.38 / $1,086.79 / $5,008.17
| Professional | | $225.38 | $1,086.79 | $5,008.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $145.16 / $225.56 / $6,679.00
| Facility | | $145.16 | $225.56 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,042.07 / $2,416.73 / $4,295.38
| Professional | | $2,042.07 | $2,416.73 | $4,295.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.04 / $1,690.32 / $4,404.77
| Professional | | $181.04 | $1,690.32 | $4,404.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.51 / $229.95 / $584.85
| Professional | | $229.51 | $229.95 | $584.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $5,097.00 / $14,018.00
| Facility | | $55.00 | $5,097.00 | $14,018.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,206.92 / $4,363.84 / $11,575.52
| Professional | | $2,206.92 | $4,363.84 | $11,575.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,386.00 / $5,904.00 / $13,017.00
| Facility | | $2,386.00 | $5,904.00 | $13,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,133.08 / $3,233.16 / $7,756.81
| Professional | | $2,133.08 | $3,233.16 | $7,756.81 |