- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.01 / $3,772.57 / $8,373.50
| Facility | | $162.01 | $3,772.57 | $8,373.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.23 / $152.04 / $162.21
| Professional | | $102.23 | $152.04 | $162.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,432.81 / $6,690.95 / $8,644.52
| Facility | | $3,432.81 | $6,690.95 | $8,644.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,346.72 / $5,956.64 / $11,524.88
| Facility | | $3,346.72 | $5,956.64 | $11,524.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,610.55 / $7,362.50 / $13,836.50
| Facility | | $4,610.55 | $7,362.50 | $13,836.50 |
- 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
- Facility
- Modifier
- Low / Median / High Price
- $66.09 / $100.00 / $9,778.71
| Facility | | $66.09 | $100.00 | $9,778.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.85 / $121.98 / $206.62
| Professional | | $113.85 | $121.98 | $206.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.75 / $247.97 / $374.67
| Professional | | $195.75 | $247.97 | $374.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.79 / $54.00 / $131.63
| Professional | | $37.79 | $54.00 | $131.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,652.37 / $2,652.37 / $3,177.28
| Facility | | $2,652.37 | $2,652.37 | $3,177.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.22 / $285.43 / $336.48
| Professional | | $259.22 | $285.43 | $336.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,206.00 / $6,578.00 / $12,241.00
| Facility | | $3,206.00 | $6,578.00 | $12,241.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.26 / $213.44 / $353.87
| Professional | | $151.26 | $213.44 | $353.87 |