- 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
- $206.54 / $1,420.18 / $3,551.99
| Professional | | $206.54 | $1,420.18 | $3,551.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.00 / $966.90 / $3,217.68
| Facility | | $308.00 | $966.90 | $3,217.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.63 / $2,784.57 / $9,098.27
| Professional | | $189.63 | $2,784.57 | $9,098.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $195.42 / $254.05 / $499.30
| Facility | | $195.42 | $254.05 | $499.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.10 / $1,007.43 / $6,639.32
| Professional | | $257.10 | $1,007.43 | $6,639.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $170.16 / $268.85 / $6,679.00
| Facility | | $170.16 | $268.85 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,150.80 / $2,069.73 / $3,333.81
| Professional | | $1,150.80 | $2,069.73 | $3,333.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.42 / $713.93 / $4,790.35
| Professional | | $220.42 | $713.93 | $4,790.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,856.00 / $3,445.00
| Facility | | $55.00 | $1,856.00 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,324.84 / $4,239.30 / $12,622.24
| Professional | | $2,324.84 | $4,239.30 | $12,622.24 |
- 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
- $2,171.46 / $3,007.35 / $7,529.71
| Professional | | $2,171.46 | $3,007.35 | $7,529.71 |