- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $3,981.07 / $11,481.54
| Facility | | $446.68 | $3,981.07 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $954.99 / $1,949.84
| Professional | | $302.00 | $954.99 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $5,888.44 / $12,302.69
| Facility | | $3,388.44 | $5,888.44 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,096.48 / $3,019.95
| Professional | | $831.76 | $1,096.48 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $1,995.26 / $8,912.51
| Facility | | $380.19 | $1,995.26 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $380.19 / $1,659.59
| Professional | | $380.19 | $380.19 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $1,862.09 / $50,118.72
| Facility | | $512.86 | $1,862.09 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $954.99 / $2,884.03
| Professional | | $269.15 | $954.99 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $407.38 / $1,148.15
| Facility | | $316.23 | $407.38 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,290.87 / $3,090.30
| Professional | | $1,621.81 | $2,290.87 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,412.54 / $2,041.74
| Professional | | $812.83 | $1,412.54 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $50,118.72 / $75,857.76
| Facility | | $302.00 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,479.11 / $1,659.59
| Professional | | $1,174.90 | $1,479.11 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $5,128.61 / $11,481.54
| Facility | | $2,398.83 | $5,128.61 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $1,000.00 / $2,290.87
| Professional | | $281.84 | $1,000.00 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $346.74 / $1,071.52
| Facility | | $223.87 | $346.74 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,202.26 / $2,344.23
| Professional | | $776.25 | $1,202.26 | $2,344.23 |