- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $352.21 / $3,780.50 / $8,373.50
| Facility | | $352.21 | $3,780.50 | $8,373.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.20 / $318.44 / $392.43
| Professional | | $215.20 | $318.44 | $392.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,889.58 / $4,640.43 / $5,986.58
| Facility | | $3,889.58 | $4,640.43 | $5,986.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.00 / $3,823.78 / $8,642.77
| Facility | | $97.00 | $3,823.78 | $8,642.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,486.55 / $6,553.50 / $11,522.50
| Facility | | $3,486.55 | $6,553.50 | $11,522.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,921.98 / $2,050.11 / $2,216.67
| Facility | | $1,921.98 | $2,050.11 | $2,216.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,020.00 / $1,200.00 / $1,200.00
| Professional | | $1,020.00 | $1,200.00 | $1,200.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.06 / $294.55 / $332.13
| Professional | | $284.06 | $294.55 | $332.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.50 / $45.00 / $100.00
| Professional | | $31.50 | $45.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $417.40 / $491.32 / $685.10
| Professional | | $417.40 | $491.32 | $685.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,119.78 / $1,703.65 / $1,887.49
| Facility | | $1,119.78 | $1,703.65 | $1,887.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $560.33 / $636.77 / $791.32
| Professional | | $560.33 | $636.77 | $791.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,200.00 / $5,111.00 / $9,202.00
| Facility | | $2,200.00 | $5,111.00 | $9,202.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.86 / $350.83 / $586.45
| Professional | | $256.86 | $350.83 | $586.45 |