- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $441.32 / $5,107.18 / $12,424.29
| Facility | | $441.32 | $5,107.18 | $12,424.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.52 / $483.13 / $827.17
| Professional | | $326.52 | $483.13 | $827.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.36 / $365.28 / $392.16
| Professional | | $255.36 | $365.28 | $392.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,481.47 / $3,891.83 / $8,197.79
| Facility | | $1,481.47 | $3,891.83 | $8,197.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $387.02 / $504.95 / $811.40
| Professional | | $387.02 | $504.95 | $811.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $662.53 / $2,581.96
| Facility | | $580.00 | $662.53 | $2,581.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $385.27 / $582.49 / $1,041.33
| Professional | | $385.27 | $582.49 | $1,041.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $428.50 / $608.22 / $995.37
| Facility | | $428.50 | $608.22 | $995.37 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $753.93 / $916.50 / $1,624.08
| Facility | 50 | $753.93 | $916.50 | $1,624.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,144.91 / $2,144.91 / $2,144.91
| Professional | | $2,144.91 | $2,144.91 | $2,144.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.06 / $365.64 / $695.40
| Professional | | $75.06 | $365.64 | $695.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,946.00 / $10,257.00 / $16,249.00
| Facility | | $1,946.00 | $10,257.00 | $16,249.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $433.44 / $558.66 / $1,204.02
| Professional | | $433.44 | $558.66 | $1,204.02 |