- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $1,202.26 / $24,547.09
| Facility | | $933.25 | $1,202.26 | $24,547.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,148.15 / $1,584.89
| Professional | | $776.25 | $1,148.15 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $4,786.30 / $19,952.62
| Facility | | $1,380.38 | $4,786.30 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,513.56 / $4,466.84
| Professional | | $1,071.52 | $1,513.56 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $10,715.19 / $26,302.68
| Facility | | $8,709.64 | $10,715.19 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $25,118.86 / $61,659.50
| Facility | | $1,737.80 | $25,118.86 | $61,659.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,202.26 / $2,089.30
| Professional | | $1,202.26 | $1,202.26 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,995.26 / $7,413.10
| Facility | | $1,202.26 | $1,995.26 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,778.28 / $2,691.53
| Professional | | $1,445.44 | $1,778.28 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $2,089.30 / $4,073.80
| Professional | | $1,202.26 | $2,089.30 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $4,786.30 / $19,952.62
| Facility | | $1,380.38 | $4,786.30 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,513.56 / $17,378.01
| Professional | | $1,071.52 | $1,513.56 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $16,218.10 / $27,542.29
| Facility | | $1,348.96 | $16,218.10 | $27,542.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,778.28 / $3,890.45
| Professional | | $1,202.26 | $1,778.28 | $3,890.45 |