- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $1,096.48 / $6,606.93
| Facility | | $288.40 | $1,096.48 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $323.59 / $1,071.52
| Professional | | $190.55 | $323.59 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $4,570.88 / $7,079.46
| Facility | | $2,344.23 | $4,570.88 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $398.11 / $1,000.00
| Professional | | $263.03 | $398.11 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $870.96 / $1,412.54
| Facility | | $741.31 | $870.96 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $645.65 / $912.01
| Professional | | $323.59 | $645.65 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $537.03 / $3,801.89
| Facility | | $204.17 | $537.03 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $588.84 / $831.76
| Professional | | $436.52 | $588.84 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $2,754.23 / $6,165.95
| Facility | | $218.78 | $2,754.23 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $524.81 / $2,089.30
| Professional | | $281.84 | $524.81 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $398.11
| Professional | | $32.36 | $33.11 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $602.56 / $954.99
| Professional | | $309.03 | $602.56 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $3,715.35 / $3,715.35
| Facility | | $2,511.89 | $3,715.35 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $660.69 / $1,995.26
| Professional | | $218.78 | $660.69 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $1,230.27 / $1,698.24
| Professional | | $436.52 | $1,230.27 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,801.89 / $6,456.54
| Facility | | $2,884.03 | $3,801.89 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $398.11 / $1,047.13
| Professional | | $204.17 | $398.11 | $1,047.13 |