- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $202.63 / $4,500.00 / $12,036.14
| Facility | | $202.63 | $4,500.00 | $12,036.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.23 / $224.11 / $668.37
| Professional | | $87.23 | $224.11 | $668.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,829.24 / $1,829.24 / $1,829.24
| Professional | | $1,829.24 | $1,829.24 | $1,829.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,350.61 / $4,406.97 / $8,524.51
| Facility | | $3,350.61 | $4,406.97 | $8,524.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.09 / $193.91 / $408.36
| Professional | | $92.09 | $193.91 | $408.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,091.67 / $2,091.67 / $2,091.67
| Facility | | $2,091.67 | $2,091.67 | $2,091.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.63 / $391.73 / $628.15
| Professional | | $207.63 | $391.73 | $628.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.04 / $327.25 / $2,831.35
| Facility | | $109.04 | $327.25 | $2,831.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.36 / $472.34 / $713.36
| Professional | | $308.36 | $472.34 | $713.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $252.52 / $499.92 / $2,389.42
| Facility | | $252.52 | $499.92 | $2,389.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.69 / $402.28 / $653.36
| Professional | | $226.69 | $402.28 | $653.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,679.00 / $3,167.00 / $7,772.00
| Facility | | $2,679.00 | $3,167.00 | $7,772.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.36 / $509.98 / $664.16
| Professional | | $308.36 | $509.98 | $664.16 |