- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $5,248.07 / $8,709.64
| Facility | | $1,778.28 | $5,248.07 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,023.29 / $1,348.96
| Professional | | $776.25 | $1,023.29 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $6,309.57 / $6,456.54
| Facility | | $3,162.28 | $6,309.57 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,737.80 / $2,754.23
| Professional | | $1,445.44 | $1,737.80 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $2,754.23 / $3,548.13
| Facility | | $100.00 | $2,754.23 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $954.99 / $2,089.30
| Professional | | $741.31 | $954.99 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,659.59 / $4,073.80
| Facility | | $851.14 | $1,659.59 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,380.38 / $1,905.46
| Professional | | $1,258.93 | $1,380.38 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,380.38 / $2,238.72
| Professional | | $1,148.15 | $1,380.38 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $6,025.60 / $6,025.60
| Facility | | $6,025.60 | $6,025.60 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,309.57 / $9,549.93 / $9,549.93
| Professional | | $6,309.57 | $9,549.93 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $1,513.56 / $2,884.03
| Facility | | $933.25 | $1,513.56 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,380.38 / $1,380.38
| Professional | | $1,258.93 | $1,380.38 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,412.54 / $19,054.61
| Professional | | $1,023.29 | $1,412.54 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $1,258.93 / $1,258.93
| Facility | | $537.03 | $1,258.93 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $537.03 / $2,454.71
| Professional | | $537.03 | $537.03 | $2,454.71 |