- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $264.35 / $3,780.50 / $8,373.50
| Facility | | $264.35 | $3,780.50 | $8,373.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.80 / $241.99 / $285.95
| Professional | | $192.80 | $241.99 | $285.95 |
- 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
- $4,610.55 / $7,313.50 / $12,775.00
| Facility | | $4,610.55 | $7,313.50 | $12,775.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,616.49 / $6,700.73 / $8,644.52
| Facility | | $5,616.49 | $6,700.73 | $8,644.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.90 / $100.00 / $9,724.66
| Facility | | $66.90 | $100.00 | $9,724.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.93 / $294.32 / $461.13
| Professional | | $253.93 | $294.32 | $461.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.71 / $301.54 / $353.50
| Professional | | $214.71 | $301.54 | $353.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.35 / $347.64 / $714.64
| Professional | | $243.35 | $347.64 | $714.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.93 / $856.24 / $2,818.17
| Facility | | $630.93 | $856.24 | $2,818.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $521.88 / $607.39 / $1,058.61
| Professional | | $521.88 | $607.39 | $1,058.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $6,231.00 / $11,869.99
| Facility | | $2,912.00 | $6,231.00 | $11,869.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.35 / $399.27 / $607.58
| Professional | | $258.35 | $399.27 | $607.58 |