- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $4,073.80 / $11,748.98
| Facility | | $549.54 | $4,073.80 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $1,445.44 / $3,019.95
| Professional | | $371.54 | $1,445.44 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $9,772.37 / $18,620.87
| Facility | | $4,570.88 | $9,772.37 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,905.46 / $5,128.61
| Professional | | $1,445.44 | $1,905.46 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $1,995.26 / $16,595.87
| Facility | | $512.86 | $1,995.26 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $512.86 / $2,754.23
| Professional | | $512.86 | $512.86 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $616.60 / $50,118.72
| Facility | | $34.67 | $616.60 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $1,318.26 / $4,466.84
| Professional | | $316.23 | $1,318.26 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $489.78 / $1,230.27
| Facility | | $346.74 | $489.78 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,691.53 / $3,630.78
| Professional | | $1,862.09 | $2,691.53 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,995.26 / $3,235.94
| Professional | | $1,318.26 | $1,995.26 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $50,118.72 / $75,857.76
| Facility | | $407.38 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,570.40 / $2,884.03
| Professional | | $2,089.30 | $2,570.40 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $6,456.54 / $16,595.87
| Facility | | $2,511.89 | $6,456.54 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $1,584.89 / $3,801.89
| Professional | | $354.81 | $1,584.89 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $457.09 / $602.56
| Facility | | $295.12 | $457.09 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $1,698.24 / $3,019.95
| Professional | | $575.44 | $1,698.24 | $3,019.95 |