- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,041.74 / $13,182.57
| Facility | | $1,584.89 | $2,041.74 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $851.14 / $2,187.76
| Professional | | $724.44 | $851.14 | $2,187.76 |
- 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
- $812.83 / $1,412.54 / $2,187.76
| Professional | | $812.83 | $1,412.54 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,584.89 / $1,905.46
| Professional | | $1,202.26 | $1,584.89 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,230.27 / $1,949.84
| Facility | | $758.58 | $1,230.27 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,412.54 / $2,041.74
| Professional | | $1,202.26 | $1,412.54 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,513.56 / $1,621.81
| Facility | | $1,288.25 | $1,513.56 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,202.26 / $1,737.80
| Facility | | $794.33 | $1,202.26 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $1,479.11 / $2,137.96
| Professional | | $79.43 | $1,479.11 | $2,137.96 |
- 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
- $1,412.54 / $1,621.81 / $2,344.23
| Professional | | $1,412.54 | $1,621.81 | $2,344.23 |
- 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
- $1,047.13 / $1,513.56 / $2,137.96
| Professional | | $1,047.13 | $1,513.56 | $2,137.96 |