- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $4,365.16 / $4,365.16
| Facility | | $199.53 | $4,365.16 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,511.89 / $3,981.07
| Professional | | $1,737.80 | $2,511.89 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $724.44 / $2,238.72
| Professional | | $407.38 | $724.44 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,905.46 / $3,019.95
| Facility | | $1,621.81 | $1,905.46 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $1,230.27 / $2,344.23
| Professional | | $457.09 | $1,230.27 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $2,511.89 / $12,882.50
| Facility | | $467.74 | $2,511.89 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $1,000.00 / $1,348.96
| Professional | | $181.97 | $1,000.00 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,737.80 / $8,128.31
| Facility | | $467.74 | $1,737.80 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $2,630.27 / $6,918.31
| Professional | | $676.08 | $2,630.27 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $58.88 / $537.03
| Professional | | $32.36 | $58.88 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $1,000.00 / $1,513.56
| Professional | | $562.34 | $1,000.00 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $8,912.51 / $8,912.51
| Facility | | $6,165.95 | $8,912.51 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $2,137.96 / $6,918.31
| Professional | | $602.56 | $2,137.96 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,479.11 / $1,479.11
| Professional | | $1,479.11 | $1,479.11 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $3,715.35 / $4,265.80
| Professional | | $1,479.11 | $3,715.35 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $8,317.64 / $10,964.78
| Facility | | $8,317.64 | $8,317.64 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $2,344.23 / $5,370.32
| Professional | | $758.58 | $2,344.23 | $5,370.32 |