- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,882.66 / $6,558.76 / $18,029.59
| Facility | | $1,882.66 | $6,558.76 | $18,029.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,368.06 / $2,083.46 / $2,133.67
| Professional | | $1,368.06 | $2,083.46 | $2,133.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $614.00 / $4,715.93 / $12,498.34
| Facility | | $614.00 | $4,715.93 | $12,498.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,500.00 / $1,785.00 / $2,820.00
| Professional | | $1,500.00 | $1,785.00 | $2,820.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $59.30 / $1,814.88 / $25,018.41
| Facility | | $59.30 | $1,814.88 | $25,018.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,142.15 / $1,631.64 / $4,101.78
| Professional | | $1,142.15 | $1,631.64 | $4,101.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,843.75 / $4,209.63 / $8,402.95
| Facility | | $1,843.75 | $4,209.63 | $8,402.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,008.17 / $2,510.21 / $3,388.78
| Professional | | $2,008.17 | $2,510.21 | $3,388.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,259.19 / $2,886.74 / $5,472.26
| Professional | | $2,259.19 | $2,886.74 | $5,472.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,367.77 / $11,923.50 / $11,923.50
| Facility | | $4,367.77 | $11,923.50 | $11,923.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,551.05 / $12,551.05 / $18,826.58
| Professional | | $12,551.05 | $12,551.05 | $18,826.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,020.54 / $3,012.25 / $6,660.35
| Facility | | $2,020.54 | $3,012.25 | $6,660.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,510.21 / $2,761.23 / $3,765.32
| Professional | | $2,510.21 | $2,761.23 | $3,765.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,510.21 / $2,510.21 / $2,510.21
| Professional | | $2,510.21 | $2,510.21 | $2,510.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,008.17 / $2,259.19 / $3,413.89
| Professional | | $2,008.17 | $2,259.19 | $3,413.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,054.29 / $1,171.43 / $5,025.99
| Professional | | $1,054.29 | $1,171.43 | $5,025.99 |