- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $827.76 / $2,079.00 / $3,625.00
| Facility | | $827.76 | $2,079.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.99 / $671.59 / $1,257.19
| Professional | | $181.99 | $671.59 | $1,257.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $350.74 / $2,575.00 / $5,714.00
| Facility | | $350.74 | $2,575.00 | $5,714.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.72 / $1,207.02 / $5,191.20
| Professional | | $181.72 | $1,207.02 | $5,191.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $184.69 / $240.10 / $471.88
| Facility | | $184.69 | $240.10 | $471.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.71 / $838.59 / $2,373.82
| Professional | | $238.71 | $838.59 | $2,373.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $161.68 / $336.76 / $6,679.00
| Facility | | $161.68 | $336.76 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $470.30 / $906.55 / $1,362.43
| Professional | | $470.30 | $906.55 | $1,362.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.21 / $888.01 / $1,966.94
| Professional | | $203.21 | $888.01 | $1,966.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,436.96 / $4,436.96 / $4,436.96
| Facility | | $4,436.96 | $4,436.96 | $4,436.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $9,039.00
| Facility | | $55.00 | $2,854.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,021.11 / $1,930.35 / $5,191.20
| Professional | | $1,021.11 | $1,930.35 | $5,191.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $8,766.00
| Facility | | $1,902.00 | $3,764.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $937.95 / $1,325.78 / $2,860.35
| Professional | | $937.95 | $1,325.78 | $2,860.35 |