- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $2,691.53 / $8,317.64
| Facility | | $724.44 | $2,691.53 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $190.55 / $616.60
| Professional | | $112.20 | $190.55 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,570.40 / $57,543.99
| Facility | | $2,344.23 | $2,570.40 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $316.23 / $380.19
| Professional | | $213.80 | $316.23 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $204.17 / $363.08
| Professional | | $125.89 | $204.17 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $363.08 / $398.11
| Professional | | $281.84 | $363.08 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $281.84 / $416.87
| Professional | | $169.82 | $281.84 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $2,754.23 / $2,754.23
| Facility | | $2,754.23 | $2,754.23 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $2,344.23 / $8,317.64
| Facility | | $616.60 | $2,344.23 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $208.93 / $645.65
| Professional | | $114.82 | $208.93 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $194.98 / $194.98
| Professional | | $194.98 | $194.98 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $165.96 / $309.03
| Facility | | $100.00 | $165.96 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $128.82 / $234.42
| Professional | | $95.50 | $128.82 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $1,318.26 / $3,890.45
| Facility | | $223.87 | $1,318.26 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $186.21 / $323.59
| Professional | | $117.49 | $186.21 | $323.59 |