- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,290.87 / $13,182.57
| Facility | | $1,778.28 | $2,290.87 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,148.15 / $2,187.76
| Professional | | $776.25 | $1,148.15 | $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
- $933.25 / $1,584.89 / $2,398.83
| Professional | | $933.25 | $1,584.89 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,862.09 / $2,187.76
| Professional | | $1,412.54 | $1,862.09 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,380.38 / $2,089.30
| Facility | | $891.25 | $1,380.38 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,513.56 / $2,290.87
| Professional | | $1,288.25 | $1,513.56 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,621.81 / $1,778.28
| Facility | | $1,202.26 | $1,621.81 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,380.38 / $1,949.84
| Facility | | $891.25 | $1,380.38 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $1,621.81 / $2,398.83
| Professional | | $79.43 | $1,621.81 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $22,387.21 / $27,542.29
| Facility | | $11,748.98 | $22,387.21 | $27,542.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,819.70 / $2,511.89
| Professional | | $1,479.11 | $1,819.70 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $13,182.57 / $31,622.78
| Facility | | $2,137.96 | $13,182.57 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,621.81 / $2,344.23
| Professional | | $1,096.48 | $1,621.81 | $2,344.23 |