- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $4,786.30 / $8,317.64
| Facility | | $1,174.90 | $4,786.30 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,174.90 / $2,630.27
| Professional | | $794.33 | $1,174.90 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $7,585.78 / $57,543.99
| Facility | | $6,456.54 | $7,585.78 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,659.59 / $1,659.59
| Professional | | $1,659.59 | $1,659.59 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,174.90 / $1,995.26
| Professional | | $794.33 | $1,174.90 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,659.59 / $1,819.70
| Professional | | $1,288.25 | $1,659.59 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,380.38 / $1,905.46
| Professional | | $891.25 | $1,380.38 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,302.68 / $26,302.68 / $26,302.68
| Facility | | $26,302.68 | $26,302.68 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $3,890.45 / $8,317.64
| Facility | | $1,023.29 | $3,890.45 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,318.26 / $3,019.95
| Professional | | $933.25 | $1,318.26 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $707.95 / $2,290.87
| Facility | | $707.95 | $707.95 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $1,778.28 / $2,238.72
| Professional | | $660.69 | $1,778.28 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $467.74 / $1,047.13
| Facility | | $467.74 | $467.74 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $870.96 / $1,071.52
| Professional | | $467.74 | $870.96 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $3,548.13 / $18,197.01
| Facility | | $1,348.96 | $3,548.13 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,096.48 / $2,041.74
| Professional | | $758.58 | $1,096.48 | $2,041.74 |