- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $4,786.30 / $8,317.64
| Facility | | $1,047.13 | $4,786.30 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $213.80 / $501.19
| Professional | | $181.97 | $213.80 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $6,165.95 / $57,543.99
| Facility | | $5,011.87 | $6,165.95 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $302.00 / $436.52
| Professional | | $186.21 | $302.00 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $281.84 / $436.52
| Professional | | $181.97 | $281.84 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $257.04 / $281.84
| Professional | | $199.53 | $257.04 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $251.19 / $407.38
| Professional | | $186.21 | $251.19 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $3,801.89 / $8,317.64
| Facility | | $831.76 | $3,801.89 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $251.19 / $1,000.00
| Professional | | $190.55 | $251.19 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $389.05 / $389.05
| Facility | | $389.05 | $389.05 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $346.74 / $446.68
| Professional | | $251.19 | $346.74 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $190.55 / $208.93
| Facility | | $141.25 | $190.55 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $190.55 / $416.87
| Professional | | $141.25 | $190.55 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,981.07 / $21,877.62
| Facility | | $2,137.96 | $3,981.07 | $21,877.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $239.88 / $398.11
| Professional | | $169.82 | $239.88 | $398.11 |