- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $227.12 / $2,094.00 / $3,685.00
| Facility | | $227.12 | $2,094.00 | $3,685.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.78 / $281.27 / $2,471.63
| Professional | | $159.78 | $281.27 | $2,471.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $759.74 / $5,097.00 / $15,000.00
| Facility | | $759.74 | $5,097.00 | $15,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.27 / $2,500.57 / $14,708.64
| Professional | | $275.27 | $2,500.57 | $14,708.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $378.17 / $485.95 / $966.22
| Facility | | $378.17 | $485.95 | $966.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $481.79 / $2,102.21 / $5,595.23
| Professional | | $481.79 | $2,102.21 | $5,595.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.91 / $811.37 / $5,381.22
| Professional | | $262.91 | $811.37 | $5,381.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $517.16 / $8,090.00
| Facility | | $300.00 | $517.16 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,404.80 / $2,933.97 / $4,126.50
| Professional | | $2,404.80 | $2,933.97 | $4,126.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $442.00 / $2,139.79 / $6,049.31
| Professional | | $442.00 | $2,139.79 | $6,049.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,957.91 / $1,957.91 / $9,755.68
| Facility | | $1,957.91 | $1,957.91 | $9,755.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,386.00 / $5,904.00 / $15,421.00
| Facility | | $2,386.00 | $5,904.00 | $15,421.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.72 / $3,713.77 / $14,708.64
| Professional | | $295.72 | $3,713.77 | $14,708.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,386.00 / $5,904.00 / $15,421.00
| Facility | | $2,386.00 | $5,904.00 | $15,421.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.39 / $2,701.00 / $6,292.63
| Professional | | $260.39 | $2,701.00 | $6,292.63 |