- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $363.08 / $1,905.46
| Facility | | $186.21 | $363.08 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $223.87 / $758.58
| Professional | | $169.82 | $223.87 | $758.58 |
- 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
- $213.80 / $426.58 / $1,000.00
| Professional | | $213.80 | $426.58 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $691.83 / $1,122.02
| Facility | | $602.56 | $691.83 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $549.54 / $831.76
| Professional | | $263.03 | $549.54 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $436.52 / $3,715.35
| Facility | | $194.98 | $436.52 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $489.78 / $676.08
| Professional | | $380.19 | $489.78 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $467.74 / $5,623.41
| Facility | | $194.98 | $467.74 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $426.58 / $2,344.23
| Professional | | $223.87 | $426.58 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $295.12
| Professional | | $32.36 | $33.11 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $501.19 / $741.31
| Professional | | $245.47 | $501.19 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $5,623.41 / $5,623.41
| Facility | | $3,801.89 | $5,623.41 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $562.34 / $2,344.23
| Professional | | $204.17 | $562.34 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $851.14 / $1,096.48
| Professional | | $446.68 | $851.14 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,801.89 / $6,606.93
| Facility | | $2,884.03 | $3,801.89 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $323.59 / $870.96
| Professional | | $177.83 | $323.59 | $870.96 |