- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,398.83 / $21,877.62
| Facility | | $1,862.09 | $2,398.83 | $21,877.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,023.29 / $2,290.87
| Professional | | $812.83 | $1,023.29 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $2,041.74 / $2,884.03
| Professional | | $954.99 | $2,041.74 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,737.80 / $2,290.87
| Professional | | $1,318.26 | $1,737.80 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $1,584.89 / $3,162.28
| Facility | | $933.25 | $1,584.89 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,621.81 / $2,398.83
| Professional | | $1,348.96 | $1,621.81 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,737.80 / $1,862.09
| Facility | | $1,380.38 | $1,737.80 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $1,380.38 / $2,290.87
| Facility | | $954.99 | $1,380.38 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $1,778.28 / $2,511.89
| Professional | | $79.43 | $1,778.28 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $18,620.87 / $22,387.21
| Facility | | $13,803.84 | $18,620.87 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $1,995.26 / $2,511.89
| Professional | | $1,698.24 | $1,995.26 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $17,782.79 / $25,703.96
| Facility | | $2,884.03 | $17,782.79 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,778.28 / $2,511.89
| Professional | | $1,148.15 | $1,778.28 | $2,511.89 |