- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.00 / $2,045.90 / $7,799.00
| Facility | | $490.00 | $2,045.90 | $7,799.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.78 / $671.59 / $1,024.01
| Professional | | $145.78 | $671.59 | $1,024.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.69 / $3,159.00 / $14,886.03
| Facility | | $2,344.69 | $3,159.00 | $14,886.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $614.54 / $895.27 / $1,331.81
| Professional | | $614.54 | $895.27 | $1,331.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.05 / $453.52 / $1,349.76
| Professional | | $180.05 | $453.52 | $1,349.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $854.43 / $1,133.23 / $1,173.80
| Professional | | $854.43 | $1,133.23 | $1,173.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,326.97 / $4,326.97 / $4,326.97
| Facility | | $4,326.97 | $4,326.97 | $4,326.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.00 / $2,326.00 / $8,017.00
| Facility | | $540.00 | $2,326.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.24 / $680.54 / $1,330.45
| Professional | | $158.24 | $680.54 | $1,330.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $966.00 / $2,113.69
| Professional | | $3.00 | $966.00 | $2,113.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.66 / $453.52 / $1,349.82
| Professional | | $184.66 | $453.52 | $1,349.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $156.46 / $495.96 / $761.50
| Facility | | $156.46 | $495.96 | $761.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.46 / $708.78 / $784.12
| Professional | | $156.46 | $708.78 | $784.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,334.00 / $2,824.00 / $5,678.00
| Facility | | $1,334.00 | $2,824.00 | $5,678.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $721.07 / $920.16 / $1,451.22
| Professional | | $721.07 | $920.16 | $1,451.22 |