- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $3,890.45 / $17,378.01
| Facility | | $707.95 | $3,890.45 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $933.25 / $3,715.35
| Professional | | $380.19 | $933.25 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $524.81 / $2,630.27
| Professional | | $251.19 | $524.81 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $10,471.29 / $40,738.03
| Facility | | $724.44 | $10,471.29 | $40,738.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $512.86 / $831.76
| Professional | | $407.38 | $512.86 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $1,513.56 / $3,019.95
| Professional | | $389.05 | $1,513.56 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $12,302.69 / $21,877.62
| Facility | | $1,071.52 | $12,302.69 | $21,877.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $831.76 / $3,388.44
| Professional | | $426.58 | $831.76 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $2,041.74 / $11,481.54
| Facility | | $407.38 | $2,041.74 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $380.19 / $380.19 / $380.19
| Facility | 53 | $380.19 | $380.19 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,951.21 / $16,982.44
| Professional | | $1,659.59 | $2,951.21 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $4,897.79 / $11,481.54
| Facility | | $2,884.03 | $4,897.79 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $1,445.44 / $3,090.30
| Professional | | $416.87 | $1,445.44 | $3,090.30 |