- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $209.16 / $2,490.86 / $8,888.49
| Facility | | $209.16 | $2,490.86 | $8,888.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.16 / $1,122.46 / $1,972.00
| Professional | | $209.16 | $1,122.46 | $1,972.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,060.00 / $7,344.00 / $10,517.23
| Facility | | $5,060.00 | $7,344.00 | $10,517.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $387.34 / $1,572.01 / $5,984.91
| Professional | | $387.34 | $1,572.01 | $5,984.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,442.28 / $4,022.57 / $6,488.27
| Facility | | $3,442.28 | $4,022.57 | $6,488.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $344.39 / $1,022.20 / $4,548.08
| Professional | | $344.39 | $1,022.20 | $4,548.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $209.16 / $462.38 / $1,856.86
| Facility | | $209.16 | $462.38 | $1,856.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $226.32 / $1,239.00 / $2,380.16
| Facility | | $226.32 | $1,239.00 | $2,380.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,389.78 / $4,000.15 / $7,333.07
| Professional | | $1,389.78 | $4,000.15 | $7,333.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.00 / $1,166.90 / $3,054.25
| Professional | | $85.00 | $1,166.90 | $3,054.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $209.16 / $462.38 / $1,856.86
| Facility | | $209.16 | $462.38 | $1,856.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $476.30 / $1,161.69 / $4,245.64
| Professional | | $476.30 | $1,161.69 | $4,245.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,196.60 / $2,196.60 / $2,196.60
| Facility | | $2,196.60 | $2,196.60 | $2,196.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.97 / $2,394.04 / $9,286.08
| Professional | | $286.97 | $2,394.04 | $9,286.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,217.63 / $5,554.46 / $7,567.90
| Professional | | $1,217.63 | $5,554.46 | $7,567.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,034.00 / $1,423.00 / $2,202.90
| Facility | | $1,034.00 | $1,423.00 | $2,202.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,388.31 / $3,707.47 / $6,313.31
| Professional | | $1,388.31 | $3,707.47 | $6,313.31 |