- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $1,905.46 / $6,606.93
| Facility | | $177.83 | $1,905.46 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $1,513.56 / $2,630.27
| Professional | | $173.78 | $1,513.56 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $1,949.84 / $7,079.46
| Professional | | $281.84 | $1,949.84 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $5,754.40 / $9,120.11
| Facility | | $4,897.79 | $5,754.40 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $1,698.24 / $6,606.93
| Professional | | $302.00 | $1,698.24 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $2,570.40 / $3,801.89
| Facility | | $204.17 | $2,570.40 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $645.65 / $5,248.07
| Professional | | $371.54 | $645.65 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $1,445.44 / $2,754.23
| Facility | | $190.55 | $1,445.44 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $3,388.44 / $9,332.54
| Professional | | $1,905.46 | $3,388.44 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $70.79
| Professional | | $32.36 | $33.11 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $1,949.84 / $6,025.60
| Professional | | $309.03 | $1,949.84 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $446.68 / $5,495.41
| Facility | | $446.68 | $446.68 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $3,235.94 / $12,589.25
| Professional | | $234.42 | $3,235.94 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $891.25 / $10,000.00
| Professional | | $891.25 | $891.25 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $10,232.93 / $13,489.63
| Professional | | $1,023.29 | $10,232.93 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,584.89 / $1,949.84
| Facility | | $1,023.29 | $1,584.89 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $1,621.81 / $6,918.31
| Professional | | $223.87 | $1,621.81 | $6,918.31 |