- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,445.16 / $3,987.44 / $7,957.63
| Facility | | $2,445.16 | $3,987.44 | $7,957.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,043.72 / $2,394.07 / $2,744.42
| Professional | | $2,043.72 | $2,394.07 | $2,744.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,582.24 / $4,810.77 / $12,737.34
| Facility | | $1,582.24 | $4,810.77 | $12,737.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,415.93 / $4,087.44 / $5,167.68
| Facility | | $3,415.93 | $4,087.44 | $5,167.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,850.00 / $10,500.00 / $18,340.00
| Facility | | $3,850.00 | $10,500.00 | $18,340.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $59.40 / $3,853.87 / $26,188.81
| Facility | | $59.40 | $3,853.87 | $26,188.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,919.60 / $2,919.60 / $2,919.60
| Professional | | $2,919.60 | $2,919.60 | $2,919.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,919.60 / $2,919.60 / $4,437.79
| Professional | | $2,919.60 | $2,919.60 | $4,437.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,167.83 / $1,197.03 / $2,861.85
| Professional | | $1,167.83 | $1,197.03 | $2,861.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,328.42 / $1,897.74 / $4,745.30
| Professional | | $1,328.42 | $1,897.74 | $4,745.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,751.76 / $1,751.76 / $2,481.66
| Professional | | $1,751.76 | $1,751.76 | $2,481.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,218.46 / $4,312.79 / $8,919.37
| Facility | | $2,218.46 | $4,312.79 | $8,919.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,556.09 / $3,556.09 / $4,260.59
| Professional | | $3,556.09 | $3,556.09 | $4,260.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,773.62 / $2,773.62 / $3,503.51
| Facility | | $2,773.62 | $2,773.62 | $3,503.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,226.23 / $1,751.76 / $3,302.07
| Professional | | $1,226.23 | $1,751.76 | $3,302.07 |