- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,511.89 / $13,182.57
| Facility | | $1,905.46 | $2,511.89 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,096.48 / $2,630.27
| Professional | | $891.25 | $1,096.48 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $851.14
| Facility | | $851.14 | $851.14 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,737.80 / $2,630.27
| Professional | | $1,071.52 | $1,737.80 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,905.46 / $2,344.23
| Professional | | $1,445.44 | $1,905.46 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $1,659.59 / $2,818.38
| Facility | | $954.99 | $1,659.59 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,778.28 / $2,511.89
| Professional | | $1,479.11 | $1,778.28 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,862.09 / $1,949.84
| Facility | | $1,479.11 | $1,862.09 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,621.81 / $2,344.23
| Facility | | $977.24 | $1,621.81 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $1,862.09 / $2,570.40
| Professional | | $79.43 | $1,862.09 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,982.44 / $22,387.21 / $27,542.29
| Facility | | $16,982.44 | $22,387.21 | $27,542.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $1,995.26 / $2,884.03
| Professional | | $1,737.80 | $1,995.26 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $17,782.79 / $31,622.78
| Facility | | $2,884.03 | $17,782.79 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,862.09 / $2,630.27
| Professional | | $1,318.26 | $1,862.09 | $2,630.27 |