- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,737.80 / $14,454.40
| Facility | | $831.76 | $1,737.80 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $912.01 / $2,187.76
| Professional | | $794.33 | $912.01 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $4,786.30 / $7,585.78
| Facility | | $3,311.31 | $4,786.30 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,698.24 / $4,073.80
| Professional | | $812.83 | $1,698.24 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,570.40 / $4,168.69
| Facility | | $2,238.72 | $2,570.40 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $3,467.37 / $3,981.07
| Professional | | $1,047.13 | $3,467.37 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,659.59 / $5,495.41
| Facility | | $831.76 | $1,659.59 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,041.74 / $2,630.27
| Professional | | $1,513.56 | $2,041.74 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,737.80 / $5,248.07
| Facility | | $851.14 | $1,737.80 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,445.44 / $6,456.54
| Professional | | $812.83 | $1,445.44 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $70.79
| Professional | | $32.36 | $33.11 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,238.72 / $3,235.94
| Professional | | $1,479.11 | $2,238.72 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $6,165.95 / $6,165.95
| Facility | | $2,187.76 | $6,165.95 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $3,981.07 / $6,309.57
| Professional | | $1,513.56 | $3,981.07 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $2,691.53 / $2,691.53
| Professional | | $2,691.53 | $2,691.53 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $4,570.88 / $5,370.32
| Professional | | $2,454.71 | $4,570.88 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,801.89 / $6,456.54
| Facility | | $2,884.03 | $3,801.89 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,230.27 / $3,388.44
| Professional | | $812.83 | $1,230.27 | $3,388.44 |