- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $988.00 / $2,159.00 / $3,625.00
| Facility | | $988.00 | $2,159.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.78 / $440.13 / $6,500.00
| Professional | | $150.78 | $440.13 | $6,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $428.01 / $4,916.00 / $13,133.71
| Facility | | $428.01 | $4,916.00 | $13,133.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.81 / $4,682.89 / $13,881.14
| Professional | | $277.81 | $4,682.89 | $13,881.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $200.46 / $266.61 / $512.17
| Facility | | $200.46 | $266.61 | $512.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.73 / $328.73 / $5,300.67
| Professional | | $328.73 | $328.73 | $5,300.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.88 / $2,404.71 / $8,006.17
| Professional | | $266.88 | $2,404.71 | $8,006.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $171.11 / $300.00 / $8,090.00
| Facility | | $171.11 | $300.00 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,007.82 / $3,830.96 / $6,795.44
| Professional | | $3,007.82 | $3,830.96 | $6,795.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.16 / $2,667.26 / $6,950.56
| Professional | | $219.16 | $2,667.26 | $6,950.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $334.23 / $334.23 / $823.24
| Facility | | $334.23 | $334.23 | $823.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $4,751.20 / $12,850.00
| Facility | | $55.00 | $4,751.20 | $12,850.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,256.24 / $5,509.39 / $18,413.57
| Professional | | $1,256.24 | $5,509.39 | $18,413.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.00 / $5,097.00 / $10,764.00
| Facility | | $2,324.00 | $5,097.00 | $10,764.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,072.09 / $5,484.01 / $12,373.70
| Professional | | $4,072.09 | $5,484.01 | $12,373.70 |