- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $3,981.07 / $11,481.54
| Facility | | $524.81 | $3,981.07 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $1,071.52 / $2,041.74
| Professional | | $354.81 | $1,071.52 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $7,762.47 / $13,803.84
| Facility | | $4,073.80 | $7,762.47 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,288.25 / $3,388.44
| Professional | | $1,000.00 | $1,288.25 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $1,995.26 / $8,912.51
| Facility | | $457.09 | $1,995.26 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $457.09 / $1,819.70
| Professional | | $457.09 | $457.09 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $1,862.09 / $50,118.72
| Facility | | $562.34 | $1,862.09 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $1,047.13 / $3,019.95
| Professional | | $288.40 | $1,047.13 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $436.52 / $1,230.27
| Facility | | $338.84 | $436.52 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,905.46 / $2,630.27
| Professional | | $1,348.96 | $1,905.46 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,288.25 / $2,089.30
| Professional | | $794.33 | $1,288.25 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $50,118.72 / $75,857.76
| Facility | | $323.59 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,698.24 / $1,905.46
| Professional | | $1,348.96 | $1,698.24 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $6,456.54 / $16,595.87
| Facility | | $2,511.89 | $6,456.54 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $1,096.48 / $2,630.27
| Professional | | $338.84 | $1,096.48 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $416.87 / $1,148.15
| Facility | | $263.03 | $416.87 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,230.27 / $2,290.87
| Professional | | $776.25 | $1,230.27 | $2,290.87 |