- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $7,943.28 / $14,454.40
| Facility | | $1,949.84 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,380.38 / $5,495.41
| Professional | | $954.99 | $1,380.38 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,620.87 / $23,988.33 / $46,773.51
| Facility | | $18,620.87 | $23,988.33 | $46,773.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,548.82 / $2,089.30
| Professional | | $912.01 | $1,548.82 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,398.83 / $3,235.94
| Professional | | $1,445.44 | $2,398.83 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,949.84 / $11,220.18
| Facility | | $1,230.27 | $1,949.84 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $2,187.76 / $10,232.93
| Professional | | $1,318.26 | $2,187.76 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $2,454.71 / $3,388.44
| Professional | | $2,398.83 | $2,454.71 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,290.87 / $2,290.87
| Professional | | $2,290.87 | $2,290.87 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $4,570.88 / $13,803.84
| Facility | | $3,235.94 | $4,570.88 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,137.96 / $2,884.03
| Professional | | $1,513.56 | $2,137.96 | $2,884.03 |