- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $4,897.79 / $15,848.93
| Facility | | $1,071.52 | $4,897.79 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $398.11 / $2,344.23
| Professional | | $75.86 | $398.11 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $181.97 / $524.81
| Professional | | $181.97 | $181.97 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $6,165.95 / $13,489.63
| Facility | | $3,630.78 | $6,165.95 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $691.83 / $1,479.11
| Professional | | $104.71 | $691.83 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $389.05 / $1,174.90
| Professional | | $89.13 | $389.05 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $478.63 / $1,071.52
| Professional | | $93.33 | $478.63 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $489.78 / $630.96
| Professional | | $75.86 | $489.78 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $354.81 / $691.83
| Professional | | $70.79 | $354.81 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $56.23 / $1,148.15
| Facility | | $54.95 | $56.23 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,090.30 / $3,090.30
| Professional | | $2,630.27 | $3,090.30 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $309.03 / $512.86
| Professional | | $309.03 | $309.03 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $354.81 / $741.31
| Facility | | $83.18 | $354.81 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $489.78 / $1,071.52
| Professional | | $93.33 | $489.78 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $275.42 / $1,659.59
| Professional | | $275.42 | $275.42 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $446.68 / $891.25
| Professional | | $69.18 | $446.68 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $1,584.89 / $6,456.54
| Facility | | $588.84 | $1,584.89 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $380.19 / $1,000.00
| Professional | | $77.62 | $380.19 | $1,000.00 |