- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $457.09 / $13,489.63
| Facility | | $239.88 | $457.09 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $346.74 / $602.56
| Professional | | $208.93 | $346.74 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $4,786.30 / $7,585.78
| Facility | | $3,311.31 | $4,786.30 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $549.54 / $1,479.11
| Professional | | $269.15 | $549.54 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,202.26 / $1,905.46
| Facility | | $1,023.29 | $1,202.26 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $575.44 / $1,479.11
| Professional | | $245.47 | $575.44 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $169.82 / $338.84 / $2,238.72
| Facility | | $169.82 | $338.84 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $660.69 / $1,023.29
| Professional | | $407.38 | $660.69 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.96 / $346.74 / $5,623.41
| Facility | | $165.96 | $346.74 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $758.58 / $2,818.38
| Professional | | $323.59 | $758.58 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $281.84
| Professional | | $32.36 | $33.11 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $660.69 / $1,202.26
| Professional | | $354.81 | $660.69 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $7,943.28 / $7,943.28
| Facility | | $5,370.32 | $7,943.28 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $776.25 / $2,691.53
| Professional | | $245.47 | $776.25 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $776.25 / $1,412.54
| Professional | | $776.25 | $776.25 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,122.02 / $1,905.46
| Professional | | $741.31 | $1,122.02 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $7,413.10 / $9,120.11
| Facility | | $4,897.79 | $7,413.10 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $371.54 / $1,000.00
| Professional | | $218.78 | $371.54 | $1,000.00 |