- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $231.72 / $689.00 / $5,449.00
| Facility | | $231.72 | $689.00 | $5,449.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.41 / $580.17 / $2,752.38
| Professional | | $315.41 | $580.17 | $2,752.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,092.08 / $3,092.08 / $3,137.19
| Facility | | $3,092.08 | $3,092.08 | $3,137.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $365.29 / $3,340.12
| Professional | | $5.00 | $365.29 | $3,340.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $395.75 / $395.75 / $15,601.83
| Facility | | $395.75 | $395.75 | $15,601.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.25 / $438.71 / $4,160.18
| Professional | | $196.25 | $438.71 | $4,160.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.00 / $370.71 / $2,970.22
| Facility | | $204.00 | $370.71 | $2,970.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.00 / $251.00 / $4,781.00
| Professional | | $251.00 | $251.00 | $4,781.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $591.20 / $5,043.70
| Professional | | $5.00 | $591.20 | $5,043.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,317.00 / $14,893.00 / $22,265.00
| Facility | | $4,317.00 | $14,893.00 | $22,265.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.85 / $1,556.36 / $4,286.97
| Professional | | $210.85 | $1,556.36 | $4,286.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,273.96 / $6,273.96 / $12,000.00
| Facility | | $6,273.96 | $6,273.96 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14,003.90 / $26,497.28 / $31,753.28
| Professional | | $14,003.90 | $26,497.28 | $31,753.28 |