- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,152.77 / $4,016.00 / $11,039.70
| Facility | | $1,152.77 | $4,016.00 | $11,039.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $837.68 / $1,275.73 / $1,306.47
| Professional | | $837.68 | $1,275.73 | $1,306.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $244.00 / $614.00 / $7,700.47
| Facility | | $244.00 | $614.00 | $7,700.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $514.79 / $617.76 / $2,520.71
| Professional | | $514.79 | $617.76 | $2,520.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $92.60 / $1,111.27 / $4,334.39
| Facility | | $92.60 | $1,111.27 | $4,334.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $699.34 / $999.06 / $2,498.15
| Professional | | $699.34 | $999.06 | $2,498.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,029.26 / $2,063.06 / $5,030.27
| Facility | | $1,029.26 | $2,063.06 | $5,030.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,537.02 / $1,690.72 / $2,074.98
| Professional | | $1,537.02 | $1,690.72 | $2,074.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,383.32 / $1,767.57 / $2,935.71
| Professional | | $1,383.32 | $1,767.57 | $2,935.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,674.41 / $7,300.85 / $7,300.85
| Facility | | $2,674.41 | $7,300.85 | $7,300.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,654.36 / $7,654.36 / $11,527.65
| Professional | | $7,654.36 | $7,654.36 | $11,527.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,229.61 / $1,844.42 / $4,027.52
| Facility | | $1,229.61 | $1,844.42 | $4,027.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,537.02 / $1,690.72 / $2,305.53
| Professional | | $1,537.02 | $1,690.72 | $2,305.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,229.61 / $1,567.76 / $2,612.92
| Professional | | $1,229.61 | $1,567.76 | $2,612.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,844.42 / $1,844.42 / $1,844.42
| Facility | | $1,844.42 | $1,844.42 | $1,844.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.54 / $645.54 / $2,952.62
| Professional | | $645.54 | $645.54 | $2,952.62 |