- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $3,548.13 / $12,022.64
| Facility | | $831.76 | $3,548.13 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $660.69 / $1,202.26
| Professional | | $660.69 | $660.69 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $4,786.30 / $9,120.11
| Facility | | $2,570.40 | $4,786.30 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $436.52 / $436.52
| Professional | | $371.54 | $436.52 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.43 / $79.43 / $79.43
| Facility | | $79.43 | $79.43 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $891.25 / $1,071.52
| Professional | | $208.93 | $891.25 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45,708.82 / $45,708.82 / $45,708.82
| Facility | | $45,708.82 | $45,708.82 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,801.89 / $3,801.89
| Professional | | $3,235.94 | $3,801.89 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $1,513.56 / $6,918.31
| Facility | | $660.69 | $1,513.56 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $660.69 / $4,570.88
| Professional | | $660.69 | $660.69 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $660.69 / $1,023.29
| Facility | | $660.69 | $660.69 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $257.04 / $1,071.52
| Professional | | $79.43 | $257.04 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $5,248.07 / $10,964.78
| Facility | | $1,698.24 | $5,248.07 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $208.93 / $208.93
| Professional | | $208.93 | $208.93 | $208.93 |