- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $188.22 / $2,150.13 / $7,602.00
| Facility | | $188.22 | $2,150.13 | $7,602.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.75 / $832.77 / $1,779.95
| Professional | | $86.75 | $832.77 | $1,779.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.76 / $133.69 / $761.13
| Professional | | $82.76 | $133.69 | $761.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $110.00 / $152.00 / $1,676.00
| Facility | | $110.00 | $152.00 | $1,676.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.41 / $297.10 / $2,392.86
| Professional | | $104.41 | $297.10 | $2,392.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $150.18 / $150.18 / $1,395.73
| Facility | | $150.18 | $150.18 | $1,395.73 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $93.86 / $93.86 / $93.86
| Facility | 62 | $93.86 | $93.86 | $93.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.21 / $256.05 / $2,145.52
| Professional | | $97.21 | $256.05 | $2,145.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,494.91 / $1,494.91 / $1,627.60
| Facility | | $1,494.91 | $1,494.91 | $1,627.60 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $246.93 / $255.55 / $255.55
| Facility | 62 | $246.93 | $255.55 | $255.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,337.04 / $6,712.53 / $7,523.03
| Professional | | $3,337.04 | $6,712.53 | $7,523.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $303.00 / $814.00 / $2,127.00
| Facility | | $303.00 | $814.00 | $2,127.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,081.28 / $1,699.72 / $2,483.50
| Professional | | $1,081.28 | $1,699.72 | $2,483.50 |