- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $4,365.16 / $14,791.08
| Facility | | $186.21 | $4,365.16 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $194.98 / $309.03
| Professional | | $144.54 | $194.98 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $6,760.83 / $7,413.10
| Facility | | $5,888.44 | $6,760.83 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $426.58 / $758.58
| Professional | | $302.00 | $426.58 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $338.84 / $5,495.41
| Professional | | $234.42 | $338.84 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $1,698.24 / $1,698.24
| Facility | | $1,698.24 | $1,698.24 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,023.29 / $1,023.29
| Professional | | $1,023.29 | $1,023.29 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $102.33 / $128.82
| Professional | | $87.10 | $102.33 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $275.42 / $398.11
| Facility | | $144.54 | $275.42 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $371.54 / $10,000.00
| Facility | | $181.97 | $371.54 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $371.54 / $10,000.00
| Professional | | $181.97 | $371.54 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $9,332.54 / $19,054.61
| Facility | | $5,128.61 | $9,332.54 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $316.23 / $549.54
| Professional | | $204.17 | $316.23 | $549.54 |