- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $7,762.47 / $20,892.96
| Facility | | $1,621.81 | $7,762.47 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $912.01 / $2,238.72
| Professional | | $741.31 | $912.01 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $870.96 / $4,466.84
| Facility | | $707.95 | $870.96 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,348.96 / $2,630.27
| Professional | | $794.33 | $1,348.96 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,621.81 / $3,890.45
| Facility | | $776.25 | $1,621.81 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,584.89 / $2,818.38
| Professional | | $776.25 | $1,584.89 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $104.71
| Professional | | $32.36 | $33.11 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,548.82 / $1,698.24
| Facility | | $1,148.15 | $1,548.82 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,148.15 / $1,174.90
| Facility | | $1,148.15 | $1,148.15 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,819.70 / $2,398.83
| Professional | | $1,174.90 | $1,819.70 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $9,120.11 / $17,378.01
| Facility | | $6,165.95 | $9,120.11 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,621.81 / $2,187.76
| Professional | | $1,174.90 | $1,621.81 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $11,220.18 / $18,620.87
| Facility | | $2,454.71 | $11,220.18 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,202.26 / $2,238.72
| Professional | | $812.83 | $1,202.26 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $954.99 / $1,584.89
| Professional | | $831.76 | $954.99 | $1,584.89 |