- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $248.61 / $1,151.78 / $3,694.69
| Facility | | $248.61 | $1,151.78 | $3,694.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.77 / $1,426.01 / $5,862.68
| Professional | | $266.77 | $1,426.01 | $5,862.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,989.00 / $10,355.00 / $24,288.00
| Facility | | $4,989.00 | $10,355.00 | $24,288.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,183.39 / $1,633.12 / $5,605.04
| Professional | | $1,183.39 | $1,633.12 | $5,605.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.56 / $1,254.00 / $4,050.00
| Facility | | $295.56 | $1,254.00 | $4,050.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.56 / $295.56 / $2,350.51
| Professional | | $295.56 | $295.56 | $2,350.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $314.56 / $314.56 / $314.56
| Professional | | $314.56 | $314.56 | $314.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $243.86 / $323.00 / $558.79
| Facility | | $243.86 | $323.00 | $558.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,390.87 / $1,821.47 / $2,406.21
| Professional | | $1,390.87 | $1,821.47 | $2,406.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.93 / $1,755.09 / $2,559.88
| Professional | | $1,096.93 | $1,755.09 | $2,559.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.27 / $2,176.33 / $2,579.53
| Professional | | $255.27 | $2,176.33 | $2,579.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $555.00 / $597.00 / $74,999.25
| Facility | | $555.00 | $597.00 | $74,999.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,790.75 / $2,546.40 / $6,801.45
| Professional | | $1,790.75 | $2,546.40 | $6,801.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,316.14 / $2,582.57 / $5,550.07
| Professional | | $1,316.14 | $2,582.57 | $5,550.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $258.99 / $258.99 / $568.00
| Facility | | $258.99 | $258.99 | $568.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $517.47 / $1,707.92 / $2,559.88
| Professional | | $517.47 | $1,707.92 | $2,559.88 |