- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,177.00 / $1,177.00 / $1,177.00
| Facility | | $1,177.00 | $1,177.00 | $1,177.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $752.10 / $1,145.58 / $1,296.16
| Professional | | $752.10 | $1,145.58 | $1,296.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $2,396.23 / $6,840.95
| Facility | | $100.00 | $2,396.23 | $6,840.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.95 / $184.18 / $6,403.49
| Professional | | $79.95 | $184.18 | $6,403.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $136.49 / $158.76 / $201.48
| Facility | | $136.49 | $158.76 | $201.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,030.54 / $2,105.34 / $2,105.34
| Professional | | $2,030.54 | $2,105.34 | $2,105.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $936.57 / $936.57 / $936.57
| Facility | | $936.57 | $936.57 | $936.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $796.08 / $796.08 / $1,492.50
| Professional | | $796.08 | $796.08 | $1,492.50 |
- 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
- $147.53 / $147.53 / $147.53
| Professional | | $147.53 | $147.53 | $147.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $6,840.95 / $6,840.95
| Facility | | $100.00 | $6,840.95 | $6,840.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.09 / $184.18 / $6,403.49
| Professional | | $80.09 | $184.18 | $6,403.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.95 / $184.18 / $1,413.67
| Professional | | $79.95 | $184.18 | $1,413.67 |