- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $5,248.07 / $12,589.25
| Facility | | $457.09 | $5,248.07 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $1,348.96 / $2,754.23
| Professional | | $302.00 | $1,348.96 | $2,754.23 |
- 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
- $1,348.96 / $1,737.80 / $4,786.30
| Professional | | $1,348.96 | $1,737.80 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $389.05 / $8,912.51
| Facility | | $389.05 | $389.05 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $389.05 / $2,344.23
| Professional | | $389.05 | $389.05 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $478.63 / $50,118.72
| Facility | | $34.67 | $478.63 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $1,023.29 / $4,168.69
| Professional | | $269.15 | $1,023.29 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $537.03 / $977.24
| Facility | | $302.00 | $537.03 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,089.30 / $2,818.38
| Professional | | $1,479.11 | $2,089.30 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,698.24 / $2,630.27
| Professional | | $1,258.93 | $1,698.24 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $50,118.72 / $75,857.76
| Facility | | $346.74 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,187.76 / $2,454.71
| Professional | | $1,737.80 | $2,187.76 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $5,128.61 / $12,022.64
| Facility | | $2,398.83 | $5,128.61 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $1,348.96 / $3,311.31
| Professional | | $281.84 | $1,348.96 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $346.74 / $1,174.90
| Facility | | $223.87 | $346.74 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,621.81 / $2,951.21
| Professional | | $954.99 | $1,621.81 | $2,951.21 |