- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,862.09 / $14,454.40
| Facility | | $891.25 | $1,862.09 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $933.25 / $2,290.87
| Professional | | $831.76 | $933.25 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,715.19 / $15,135.61 / $26,302.68
| Facility | | $10,715.19 | $15,135.61 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,862.09 / $4,786.30
| Professional | | $891.25 | $1,862.09 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,754.23 / $4,677.35
| Facility | | $2,344.23 | $2,754.23 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $3,715.35 / $4,168.69
| Professional | | $1,148.15 | $3,715.35 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,862.09 / $6,456.54
| Facility | | $912.01 | $1,862.09 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,187.76 / $2,818.38
| Professional | | $1,621.81 | $2,187.76 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $1,949.84 / $11,481.54
| Facility | | $933.25 | $1,949.84 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,698.24 / $12,022.64
| Professional | | $954.99 | $1,698.24 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $70.79
| Professional | | $32.36 | $33.11 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,041.74 / $3,090.30
| Professional | | $1,348.96 | $2,041.74 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $13,489.63 / $19,952.62
| Facility | | $7,244.36 | $13,489.63 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $4,365.16 / $12,022.64
| Professional | | $1,621.81 | $4,365.16 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,951.21 / $2,951.21 / $2,951.21
| Professional | | $2,951.21 | $2,951.21 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $5,011.87 / $5,754.40
| Professional | | $2,570.40 | $5,011.87 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $10,232.93 / $14,454.40
| Facility | | $6,606.93 | $10,232.93 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,380.38 / $3,715.35
| Professional | | $912.01 | $1,380.38 | $3,715.35 |