- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $9,549.93 / $23,442.29
| Facility | | $3,715.35 | $9,549.93 | $23,442.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,659.59 / $5,888.44
| Professional | | $1,318.26 | $1,659.59 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $11,748.98 / $18,620.87
| Facility | | $6,918.31 | $11,748.98 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,344.23 / $4,677.35
| Professional | | $1,659.59 | $2,344.23 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.57 / $100.00 / $6,456.54
| Facility | | $64.57 | $100.00 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $2,041.74 / $4,168.69
| Professional | | $1,412.54 | $2,041.74 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,949.84 / $4,168.69
| Professional | | $1,445.44 | $1,949.84 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,621.81 / $2,187.76
| Professional | | $933.25 | $1,621.81 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,737.80 / $3,715.35
| Professional | | $1,288.25 | $1,737.80 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $56.23 / $14,125.38
| Facility | | $54.95 | $56.23 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,803.84 / $13,803.84 / $13,803.84
| Professional | | $13,803.84 | $13,803.84 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,187.76 / $2,187.76
| Professional | | $2,187.76 | $2,187.76 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,905.46 / $3,235.94
| Facility | | $1,479.11 | $1,905.46 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,995.26 / $4,073.80
| Professional | | $1,412.54 | $1,995.26 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,128.61 / $5,128.61 / $5,128.61
| Professional | | $5,128.61 | $5,128.61 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,479.11 / $1,995.26
| Professional | | $1,174.90 | $1,479.11 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $12,302.69 / $25,703.96
| Facility | | $6,760.83 | $12,302.69 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,621.81 / $3,467.37
| Professional | | $1,202.26 | $1,621.81 | $3,467.37 |