- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.03 / $3,467.37 / $14,454.40
| Facility | | $123.03 | $3,467.37 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $199.53 / $316.23
| Professional | | $128.82 | $199.53 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $10,964.78 / $18,197.01
| Facility | | $6,606.93 | $10,964.78 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $389.05 / $1,096.48
| Professional | | $190.55 | $389.05 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $691.83 / $1,122.02
| Facility | | $602.56 | $691.83 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $891.25 / $1,000.00
| Professional | | $251.19 | $891.25 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.03 / $229.09 / $457.09
| Facility | | $123.03 | $229.09 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $446.68 / $446.68
| Professional | | $446.68 | $446.68 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $8,317.64 / $15,848.93
| Facility | | $208.93 | $8,317.64 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $380.19 / $1,230.27
| Professional | | $208.93 | $380.19 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $50.12 / $208.93
| Professional | | $32.36 | $50.12 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $588.84 / $831.76
| Professional | | $331.13 | $588.84 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $5,754.40 / $8,511.38
| Facility | | $5,754.40 | $5,754.40 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,778.28 / $1,778.28
| Professional | | $1,000.00 | $1,778.28 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $776.25 / $776.25
| Professional | | $776.25 | $776.25 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,318.26 / $1,778.28
| Professional | | $1,318.26 | $1,318.26 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $12,022.64 / $16,218.10
| Facility | | $6,918.31 | $12,022.64 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $331.13 / $954.99
| Professional | | $204.17 | $331.13 | $954.99 |