- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $7,244.36 / $11,220.18
| Facility | | $1,513.56 | $7,244.36 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,621.81 / $3,235.94
| Professional | | $707.95 | $1,621.81 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $10,000.00 / $57,543.99
| Facility | | $9,549.93 | $10,000.00 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,071.52 / $1,148.15
| Professional | | $1,071.52 | $1,071.52 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,288.25 / $1,288.25
| Facility | | $1,288.25 | $1,288.25 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,621.81 / $3,311.31
| Professional | | $758.58 | $1,621.81 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,951.21 / $3,715.35
| Professional | | $2,137.96 | $2,951.21 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $2,041.74 / $2,951.21
| Professional | | $977.24 | $2,041.74 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $14,454.40 / $22,387.21
| Facility | | $12,589.25 | $14,454.40 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $5,623.41 / $11,220.18
| Facility | | $1,288.25 | $5,623.41 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,862.09 / $4,786.30
| Professional | | $758.58 | $1,862.09 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,047.13 / $3,801.89
| Facility | | $1,047.13 | $1,047.13 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,348.96 / $4,897.79
| Professional | | $933.25 | $1,348.96 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $1,258.93 / $1,949.84
| Facility | | $741.31 | $1,258.93 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $933.25 / $1,819.70
| Professional | | $724.44 | $933.25 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $4,466.84 / $18,197.01
| Facility | | $2,344.23 | $4,466.84 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,513.56 / $3,090.30
| Professional | | $724.44 | $1,513.56 | $3,090.30 |