- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $1,995.26 / $10,232.93
| Facility | | $645.65 | $1,995.26 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $1,023.29 / $8,709.64
| Professional | | $645.65 | $1,023.29 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $1,000.00 / $1,819.70
| Professional | | $436.52 | $1,000.00 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $69.18 / $2,290.87 / $9,549.93
| Facility | | $69.18 | $2,290.87 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $1,288.25 / $5,248.07
| Professional | | $524.81 | $1,288.25 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $53.70 / $117.49 / $1,202.26
| Facility | | $53.70 | $117.49 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $467.74 / $1,174.90
| Professional | | $309.03 | $467.74 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,047.13 / $1,380.38
| Professional | | $891.25 | $1,047.13 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50,118.72 / $53,703.18 / $75,857.76
| Facility | | $50,118.72 | $53,703.18 | $75,857.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $478.63 / $707.95
| Facility | | $338.84 | $478.63 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $724.44 / $1,778.28
| Professional | | $398.11 | $724.44 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $891.25 / $1,202.26
| Facility | | $363.08 | $891.25 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,023.29 / $1,548.82
| Professional | | $851.14 | $1,023.29 | $1,548.82 |