- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $90.05 / $1,100.61 / $3,153.23
| Facility | | $90.05 | $1,100.61 | $3,153.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.13 / $394.83 / $1,607.75
| Professional | | $86.13 | $394.83 | $1,607.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.98 / $67.95 / $6,773.34
| Facility | | $0.98 | $67.95 | $6,773.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.93 / $660.89 / $3,169.07
| Professional | | $183.93 | $660.89 | $3,169.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,161.96 / $3,374.28 / $8,117.28
| Facility | | $2,161.96 | $3,374.28 | $8,117.28 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $93.86 / $93.86 / $93.86
| Facility | 62 | $93.86 | $93.86 | $93.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.07 / $835.29 / $3,701.60
| Professional | | $139.07 | $835.29 | $3,701.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,873.54 / $2,776.98 / $6,391.56
| Facility | | $1,873.54 | $2,776.98 | $6,391.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.42 / $855.17 / $3,141.92
| Professional | | $172.42 | $855.17 | $3,141.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $106.33 / $872.03 / $2,398.08
| Facility | | $106.33 | $872.03 | $2,398.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,307.13 / $2,663.90 / $5,282.43
| Professional | | $1,307.13 | $2,663.90 | $5,282.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $563.00 / $1,749.00 / $2,883.00
| Facility | | $563.00 | $1,749.00 | $2,883.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,201.42 / $2,473.01 / $4,385.18
| Professional | | $1,201.42 | $2,473.01 | $4,385.18 |