- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $3,890.45 / $8,317.64
| Facility | | $234.42 | $3,890.45 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $1,380.38 / $6,309.57
| Professional | | $51.29 | $1,380.38 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,570.40 / $2,951.21
| Facility | | $2,137.96 | $2,570.40 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.70 / $74.13 / $109.65
| Professional | | $53.70 | $74.13 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.95 / $61.66 / $66.07
| Professional | | $54.95 | $61.66 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.72 / $97.72 / $97.72
| Facility | | $97.72 | $97.72 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26,302.68 / $26,302.68 / $26,302.68
| Professional | | $26,302.68 | $26,302.68 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,025.60 / $7,762.47 / $9,120.11
| Professional | | $6,025.60 | $7,762.47 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.48 / $2,238.72 / $8,317.64
| Facility | | $52.48 | $2,238.72 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $123.03 / $1,737.80
| Professional | | $123.03 | $123.03 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $891.25 / $10,000.00
| Facility | | $56.23 | $891.25 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $3,801.89 / $10,000.00
| Professional | | $1,174.90 | $3,801.89 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $1,230.27 / $2,570.40
| Facility | | $229.09 | $1,230.27 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $144.54 / $3,467.37
| Professional | | $51.29 | $144.54 | $3,467.37 |