- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $3,981.07 / $8,511.38
| Facility | | $831.76 | $3,981.07 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $851.14 / $2,344.23
| Professional | | $331.13 | $851.14 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $416.87 / $489.78
| Professional | | $416.87 | $416.87 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $3,801.89 / $57,543.99
| Facility | | $3,801.89 | $3,801.89 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $912.01 / $1,513.56
| Professional | | $776.25 | $912.01 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $707.95 / $1,584.89
| Professional | | $346.74 | $707.95 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,479.11 / $1,621.81
| Professional | | $1,148.15 | $1,479.11 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $1,000.00 / $1,548.82
| Professional | | $316.23 | $1,000.00 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $5,370.32 / $7,762.47
| Facility | | $2,884.03 | $5,370.32 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $3,630.78 / $8,317.64
| Facility | | $831.76 | $3,630.78 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $912.01 / $2,344.23
| Professional | | $346.74 | $912.01 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $338.84 / $2,137.96
| Facility | | $338.84 | $338.84 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $1,621.81 / $1,995.26
| Professional | | $338.84 | $1,621.81 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $467.74 / $933.25
| Facility | | $234.42 | $467.74 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $467.74 / $933.25
| Professional | | $234.42 | $467.74 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $2,754.23 / $10,232.93
| Facility | | $912.01 | $2,754.23 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $645.65 / $1,348.96
| Professional | | $288.40 | $645.65 | $1,348.96 |