- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $1,584.89 / $6,165.95
| Facility | | $144.54 | $1,584.89 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $346.74 / $1,348.96
| Professional | | $72.44 | $346.74 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $8,511.38 / $77,624.71
| Facility | | $5,011.87 | $8,511.38 | $77,624.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $645.65 / $1,000.00
| Professional | | $316.23 | $645.65 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $354.81 / $831.76
| Professional | | $91.20 | $354.81 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $562.34 / $616.60
| Professional | | $436.52 | $562.34 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $524.81 / $741.31
| Professional | | $97.72 | $524.81 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $851.14 / $3,630.78
| Facility | | $645.65 | $851.14 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $95.50 / $95.50
| Professional | | $95.50 | $95.50 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $1,348.96 / $5,754.40
| Facility | | $181.97 | $1,348.96 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $346.74 / $1,174.90
| Professional | | $75.86 | $346.74 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $645.65 / $870.96
| Facility | | $645.65 | $645.65 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $707.95 / $1,096.48
| Professional | | $616.60 | $707.95 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81.28 / $138.04 / $562.34
| Facility | | $81.28 | $138.04 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $138.04 / $407.38
| Professional | | $77.62 | $138.04 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $676.08 / $4,265.80
| Facility | | $144.54 | $676.08 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $239.88 / $776.25
| Professional | | $79.43 | $239.88 | $776.25 |