- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $7,244.36 / $11,220.18
| Facility | | $1,380.38 | $7,244.36 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,071.52 / $3,019.95
| Professional | | $812.83 | $1,071.52 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $21,379.62 / $57,543.99
| Facility | | $8,511.38 | $21,379.62 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,202.26 / $1,659.59
| Professional | | $812.83 | $1,202.26 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,148.15 / $1,819.70
| Professional | | $870.96 | $1,148.15 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,258.93 / $1,380.38
| Professional | | $977.24 | $1,258.93 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,122.02 / $1,737.80
| Professional | | $870.96 | $1,122.02 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $11,748.98 / $38,018.94
| Facility | | $7,079.46 | $11,748.98 | $38,018.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $6,025.60 / $11,220.18
| Facility | | $1,202.26 | $6,025.60 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,258.93 / $2,754.23
| Professional | | $831.76 | $1,258.93 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,174.90 / $1,905.46
| Facility | | $1,174.90 | $1,174.90 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,412.54 / $1,995.26
| Professional | | $1,023.29 | $1,412.54 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $933.25 / $1,905.46
| Facility | | $912.01 | $933.25 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $977.24 / $1,905.46
| Professional | | $912.01 | $977.24 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,090.30 / $6,025.60
| Facility | | $2,137.96 | $3,090.30 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,096.48 / $1,862.09
| Professional | | $831.76 | $1,096.48 | $1,862.09 |