- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,801.89 / $9,120.11
| Facility | | $851.14 | $3,801.89 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $630.96 / $1,621.81
| Professional | | $501.19 | $630.96 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $5,888.44 / $12,302.69
| Facility | | $3,388.44 | $5,888.44 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $645.65 / $1,412.54
| Professional | | $512.86 | $645.65 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $912.01 / $8,912.51
| Facility | | $912.01 | $912.01 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $912.01 / $912.01
| Professional | | $912.01 | $912.01 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $1,096.48 / $50,118.72
| Facility | | $34.67 | $1,096.48 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $831.76 / $2,238.72
| Professional | | $416.87 | $831.76 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $741.31 / $1,862.09
| Facility | | $457.09 | $741.31 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $851.14 / $1,380.38
| Professional | | $707.95 | $851.14 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $691.83 / $1,202.26
| Professional | | $457.09 | $691.83 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $50,118.72 / $75,857.76
| Facility | | $575.44 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $758.58 / $1,000.00
| Professional | | $398.11 | $758.58 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $3,981.07 / $8,317.64
| Facility | | $1,819.70 | $3,981.07 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $676.08 / $1,445.44
| Professional | | $371.54 | $676.08 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $691.83 / $1,905.46
| Facility | | $457.09 | $691.83 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $758.58 / $2,041.74
| Professional | | $457.09 | $758.58 | $2,041.74 |