- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $691.83 / $3,715.35
| Facility | | $269.15 | $691.83 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $338.84 / $851.14
| Professional | | $223.87 | $338.84 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $7,762.47 / $13,182.57
| Facility | | $3,981.07 | $7,762.47 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $630.96 / $1,513.56
| Professional | | $323.59 | $630.96 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,071.52 / $1,698.24
| Facility | | $912.01 | $1,071.52 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $707.95 / $1,230.27
| Professional | | $363.08 | $707.95 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $660.69 / $4,168.69
| Facility | | $309.03 | $660.69 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $660.69 / $1,000.00
| Professional | | $478.63 | $660.69 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $691.83 / $6,165.95
| Facility | | $309.03 | $691.83 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $645.65 / $2,570.40
| Professional | | $346.74 | $645.65 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $457.09
| Professional | | $32.36 | $33.11 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $676.08 / $1,174.90
| Professional | | $380.19 | $676.08 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $9,120.11 / $9,120.11
| Facility | | $6,165.95 | $9,120.11 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $741.31 / $2,454.71
| Professional | | $275.42 | $741.31 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,348.96 / $2,041.74
| Professional | | $707.95 | $1,348.96 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,801.89 / $6,606.93
| Facility | | $2,884.03 | $3,801.89 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $489.78 / $1,258.93
| Professional | | $263.03 | $489.78 | $1,258.93 |