- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $4,466.84 / $11,481.54
| Facility | | $489.78 | $4,466.84 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $363.08 / $1,000.00
| Professional | | $288.40 | $363.08 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $9,772.37 / $18,620.87
| Facility | | $4,570.88 | $9,772.37 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $316.23 / $794.33
| Professional | | $251.19 | $316.23 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $2,630.27 / $12,302.69
| Facility | | $436.52 | $2,630.27 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $436.52 / $436.52
| Professional | | $436.52 | $436.52 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $1,819.70 / $50,118.72
| Facility | | $524.81 | $1,819.70 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $588.84 / $1,348.96
| Professional | | $245.47 | $588.84 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $416.87 / $1,023.29
| Facility | | $309.03 | $416.87 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $371.54 / $537.03
| Professional | | $281.84 | $371.54 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $398.11 / $776.25
| Professional | | $269.15 | $398.11 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $50,118.72 / $75,857.76
| Facility | | $436.52 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $407.38 / $676.08
| Professional | | $380.19 | $407.38 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $5,128.61 / $12,882.50
| Facility | | $2,398.83 | $5,128.61 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $346.74 / $912.01
| Professional | | $245.47 | $346.74 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $338.84 / $1,174.90
| Facility | | $251.19 | $338.84 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $380.19 / $1,000.00
| Professional | | $251.19 | $380.19 | $1,000.00 |