- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $89.13 / $3,162.28 / $10,000.00
| Facility | | $89.13 | $3,162.28 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $275.42 / $1,995.26
| Professional | | $89.13 | $275.42 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.00 / $5,011.87 / $7,762.47
| Facility | | $1.00 | $5,011.87 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $645.65 / $2,884.03
| Professional | | $158.49 | $645.65 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $3,548.13 / $8,511.38
| Facility | | $2,238.72 | $3,548.13 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $93.33 / $93.33 / $93.33
| Facility | 62 | $93.33 | $93.33 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $446.68 / $3,388.44
| Professional | | $123.03 | $446.68 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $3,388.44 / $6,606.93
| Facility | | $2,754.23 | $3,388.44 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $891.25 / $3,162.28
| Professional | | $177.83 | $891.25 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $95.50 / $870.96 / $2,511.89
| Facility | | $95.50 | $870.96 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $2,511.89 / $6,760.83
| Professional | | $1,202.26 | $2,511.89 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $1,862.09 / $3,715.35
| Facility | | $602.56 | $1,862.09 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $977.24 / $3,090.30
| Professional | | $104.71 | $977.24 | $3,090.30 |