- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.23 / $1,513.56 / $9,332.54
| Facility | | $120.23 | $1,513.56 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $1,318.26 / $2,137.96
| Professional | | $114.82 | $1,318.26 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $4,677.35 / $13,182.57
| Facility | | $2,818.38 | $4,677.35 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $870.96 / $3,801.89
| Professional | | $199.53 | $870.96 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $302.00 / $1,318.26 / $5,495.41
| Professional | 50 | $302.00 | $1,318.26 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $4,897.79 / $11,748.98
| Facility | | $3,388.44 | $4,897.79 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $758.58 / $5,370.32
| Professional | | $245.47 | $758.58 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $4,677.35 / $9,120.11
| Facility | | $3,801.89 | $4,677.35 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $1,819.70 / $5,011.87
| Professional | | $239.88 | $1,819.70 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $2,511.89 / $5,888.44
| Facility | | $190.55 | $2,511.89 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $3,235.94 / $6,456.54
| Professional | | $1,862.09 | $3,235.94 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,265.80 / $6,760.83
| Facility | | $1,584.89 | $4,265.80 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $1,479.11 / $4,786.30
| Professional | | $169.82 | $1,479.11 | $4,786.30 |