- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $2,238.72 / $3,801.89
| Facility | | $389.05 | $2,238.72 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $263.03 / $724.44
| Professional | | $69.18 | $263.03 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,398.83 / $7,585.78
| Facility | | $56.23 | $2,398.83 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $354.81 / $1,258.93
| Professional | | $74.13 | $354.81 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.43 / $79.43 / $186.21
| Facility | | $79.43 | $79.43 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $501.19 / $1,148.15
| Professional | | $79.43 | $501.19 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $239.88 / $977.24
| Professional | | $91.20 | $239.88 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $63.10 / $177.83 / $7,079.46
| Facility | | $63.10 | $177.83 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $630.96 / $954.99
| Professional | | $501.19 | $630.96 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,248.07 / $11,220.18
| Facility | | $2,137.96 | $5,248.07 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $407.38 / $1,023.29
| Professional | | $74.13 | $407.38 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $6,918.31 / $6,918.31
| Facility | | $1,659.59 | $6,918.31 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $109.65 / $109.65
| Professional | | $109.65 | $109.65 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $3,019.95 / $9,332.54
| Facility | | $56.23 | $3,019.95 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $354.81 / $1,258.93
| Professional | | $74.13 | $354.81 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $5,248.07 / $11,220.18
| Facility | | $1,659.59 | $5,248.07 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $354.81 / $1,000.00
| Professional | | $81.28 | $354.81 | $1,000.00 |