- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,412.54 / $2,344.23
| Facility | | $891.25 | $1,412.54 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $52.48 / $1,778.28
| Professional | | $30.20 | $52.48 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,288.25 / $1,995.26
| Professional | | $794.33 | $1,288.25 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.66 / $61.66 / $53,703.18
| Facility | | $61.66 | $61.66 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,479.11 / $2,137.96
| Professional | | $831.76 | $1,479.11 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,202.26 / $1,202.26
| Facility | | $1,202.26 | $1,202.26 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $1,230.27 / $1,778.28
| Professional | | $331.13 | $1,230.27 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $1,071.52 / $1,445.44
| Professional | | $251.19 | $1,071.52 | $1,445.44 |
- 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
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,698.24 / $2,041.74
| Professional | | $794.33 | $1,698.24 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $75.86 / $120.23
| Professional | | $50.12 | $75.86 | $120.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $302.00 / $660.69
| Facility | | $302.00 | $302.00 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $1,023.29 / $1,445.44
| Professional | | $275.42 | $1,023.29 | $1,445.44 |