- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $2,818.38 / $7,585.78
| Facility | | $346.74 | $2,818.38 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $309.03 / $1,000.00
| Professional | | $190.55 | $309.03 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $97.72 / $208.93
| Professional | | $97.72 | $97.72 | $208.93 |
- 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
- $331.13 / $562.34 / $645.65
| Professional | | $331.13 | $562.34 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,041.74 / $2,041.74
| Facility | | $2,041.74 | $2,041.74 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $309.03 / $501.19
| Professional | | $204.17 | $309.03 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $562.34 / $630.96
| Professional | | $436.52 | $562.34 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $426.58 / $645.65
| Professional | | $281.84 | $426.58 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $2,630.27 / $7,244.36
| Facility | | $616.60 | $2,630.27 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $2,511.89 / $7,413.10
| Facility | | $416.87 | $2,511.89 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $338.84 / $870.96
| Professional | | $199.53 | $338.84 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $302.00 / $302.00
| Professional | | $302.00 | $302.00 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $316.23 / $602.56
| Facility | | $213.80 | $316.23 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $331.13 / $602.56
| Professional | | $213.80 | $331.13 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $2,238.72 / $4,265.80
| Facility | | $891.25 | $2,238.72 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $316.23 / $537.03
| Professional | | $194.98 | $316.23 | $537.03 |