- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $230.09 / $2,079.00 / $3,625.00
| Facility | | $230.09 | $2,079.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.19 / $247.28 / $2,752.38
| Professional | | $162.19 | $247.28 | $2,752.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $925.10 / $6,078.00 / $13,340.15
| Facility | | $925.10 | $6,078.00 | $13,340.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.31 / $3,159.73 / $26,497.28
| Professional | | $293.31 | $3,159.73 | $26,497.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.95 / $674.56 / $1,341.25
| Facility | | $524.95 | $674.56 | $1,341.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $268.77 / $903.89 / $6,232.42
| Professional | | $268.77 | $903.89 | $6,232.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $443.03 / $957.20 / $6,679.00
| Facility | | $443.03 | $957.20 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,365.42 / $5,336.25 / $7,516.45
| Professional | | $4,365.42 | $5,336.25 | $7,516.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $621.32 / $3,889.99 / $10,989.19
| Professional | | $621.32 | $3,889.99 | $10,989.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,386.00 / $6,273.96 / $12,000.00
| Facility | | $2,386.00 | $6,273.96 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $279.88 / $5,060.54 / $26,497.28
| Professional | | $279.88 | $5,060.54 | $26,497.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,386.00 / $5,720.00 / $9,012.00
| Facility | | $2,386.00 | $5,720.00 | $9,012.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.25 / $3,159.73 / $10,503.36
| Professional | | $242.25 | $3,159.73 | $10,503.36 |