- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $911.50 / $2,067.00 / $3,685.00
| Facility | | $911.50 | $2,067.00 | $3,685.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.86 / $592.20 / $1,523.37
| Professional | | $61.86 | $592.20 | $1,523.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.10 / $736.00 / $2,796.00
| Facility | | $55.10 | $736.00 | $2,796.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.60 / $1,445.81 / $4,443.00
| Professional | | $55.60 | $1,445.81 | $4,443.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.18 / $74.33 / $146.09
| Facility | | $57.18 | $74.33 | $146.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.11 / $310.47 / $3,118.63
| Professional | | $76.11 | $310.47 | $3,118.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $58.63 / $168.26 / $6,679.00
| Facility | | $58.63 | $168.26 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $535.11 / $1,032.76 / $1,550.19
| Professional | | $535.11 | $1,032.76 | $1,550.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.40 / $1,003.11 / $2,227.00
| Professional | | $63.40 | $1,003.11 | $2,227.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.52 / $295.52 / $295.52
| Facility | | $295.52 | $295.52 | $295.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.28 / $416.28 / $775.00
| Professional | | $416.28 | $416.28 | $775.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,078.00 / $3,445.00
| Facility | | $55.00 | $1,078.00 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,220.40 / $2,245.09 / $5,848.72
| Professional | | $1,220.40 | $2,245.09 | $5,848.72 |
- 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
- $1,204.83 / $1,570.86 / $3,874.91
| Professional | | $1,204.83 | $1,570.86 | $3,874.91 |