- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.04 / $2,503.71 / $2,785.51
| Facility | | $0.04 | $2,503.71 | $2,785.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,005.40 / $1,407.56 / $1,535.52
| Professional | | $1,005.40 | $1,407.56 | $1,535.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,068.23 / $2,542.21 / $3,339.48
| Facility | | $1,068.23 | $2,542.21 | $3,339.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $548.40 / $914.00 / $3,624.59
| Professional | | $548.40 | $914.00 | $3,624.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.61 / $1,230.24 / $2,285.00
| Facility | | $60.61 | $1,230.24 | $2,285.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.29 / $43.29 / $43.29
| Professional | | $43.29 | $43.29 | $43.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.04 / $660.40 / $2,079.35
| Facility | | $588.04 | $660.40 | $2,079.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $548.36 / $964.25 / $4,078.43
| Professional | | $548.36 | $964.25 | $4,078.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,319.02 / $1,319.02 / $1,551.79
| Professional | | $1,319.02 | $1,319.02 | $1,551.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $914.00 / $914.00 / $2,830.57
| Professional | | $914.00 | $914.00 | $2,830.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,590.36 / $4,341.50 / $4,341.50
| Facility | | $1,590.36 | $4,341.50 | $4,341.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $548.40 / $548.40 / $4,570.00
| Professional | | $548.40 | $548.40 | $4,570.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $548.40 / $548.40 / $1,742.15
| Professional | | $548.40 | $548.40 | $1,742.15 |