- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,905.46 / $21,877.62
| Facility | | $1,479.11 | $1,905.46 | $21,877.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $831.76 / $2,041.74
| Professional | | $676.08 | $831.76 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,659.59 / $1,659.59
| Facility | | $1,659.59 | $1,659.59 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,318.26 / $2,041.74
| Professional | | $758.58 | $1,318.26 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,445.44 / $1,778.28
| Professional | | $1,096.48 | $1,445.44 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $1,122.02 / $1,819.70
| Facility | | $741.31 | $1,122.02 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,288.25 / $1,905.46
| Professional | | $1,096.48 | $1,288.25 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,412.54 / $1,479.11
| Facility | | $1,122.02 | $1,412.54 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $1,122.02 / $1,659.59
| Facility | | $741.31 | $1,122.02 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $1,380.38 / $1,995.26
| Professional | | $79.43 | $1,380.38 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $18,620.87 / $22,387.21
| Facility | | $13,803.84 | $18,620.87 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,513.56 / $2,187.76
| Professional | | $1,288.25 | $1,513.56 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $10,232.93 / $25,703.96
| Facility | | $1,995.26 | $10,232.93 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,412.54 / $1,995.26
| Professional | | $933.25 | $1,412.54 | $1,995.26 |