- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $2,754.23 / $4,897.79
| Facility | | $524.81 | $2,754.23 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $436.52 / $1,000.00
| Professional | | $173.78 | $436.52 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $4,897.79 / $28,840.32
| Facility | | $398.11 | $4,897.79 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $489.78 / $1,202.26
| Professional | | $218.78 | $489.78 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $199.53 / $446.68
| Facility | | $199.53 | $199.53 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $346.74 / $645.65
| Professional | | $199.53 | $346.74 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $446.68 / $1,047.13
| Professional | | $218.78 | $446.68 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $501.19 / $7,079.46
| Facility | | $158.49 | $501.19 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $416.87 / $588.84
| Professional | | $331.13 | $416.87 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $4,265.80 / $9,772.37
| Facility | | $1,995.26 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $363.08 / $758.58
| Professional | | $190.55 | $363.08 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $5,623.41 / $5,754.40
| Facility | | $5,623.41 | $5,623.41 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $346.74 / $354.81
| Professional | | $144.54 | $346.74 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $4,897.79 / $28,840.32
| Facility | | $398.11 | $4,897.79 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $489.78 / $1,202.26
| Professional | | $218.78 | $489.78 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $4,265.80 / $9,772.37
| Facility | | $1,862.09 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $537.03 / $977.24
| Professional | | $302.00 | $537.03 | $977.24 |