- 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
- $182.08 / $893.51 / $1,972.75
| Professional | | $182.08 | $893.51 | $1,972.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.57 / $3,110.00 / $7,408.24
| Facility | | $323.57 | $3,110.00 | $7,408.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.62 / $1,439.54 / $4,172.53
| Professional | | $128.62 | $1,439.54 | $4,172.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $121.27 / $157.65 / $309.83
| Facility | | $121.27 | $157.65 | $309.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.02 / $674.13 / $2,547.31
| Professional | | $170.02 | $674.13 | $2,547.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.46 / $1,040.81 / $3,156.63
| Professional | | $182.46 | $1,040.81 | $3,156.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $105.37 / $214.32 / $6,679.00
| Facility | | $105.37 | $214.32 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,246.54 / $1,579.33 / $2,229.39
| Professional | | $1,246.54 | $1,579.33 | $2,229.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.80 / $1,350.86 / $3,428.48
| Professional | | $127.80 | $1,350.86 | $3,428.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $3,245.00 / $9,401.00
| Facility | | $55.00 | $3,245.00 | $9,401.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,304.69 / $1,964.25 / $7,886.96
| Professional | | $1,304.69 | $1,964.25 | $7,886.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $4,402.00 / $8,810.00
| Facility | | $2,155.00 | $4,402.00 | $8,810.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,245.08 / $1,845.78 / $3,633.12
| Professional | | $1,245.08 | $1,845.78 | $3,633.12 |