- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $10,471.29 / $23,988.33
| Facility | | $4,466.84 | $10,471.29 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,778.28 / $6,456.54
| Professional | | $1,412.54 | $1,778.28 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,220.18 / $16,982.44 / $28,840.32
| Facility | | $11,220.18 | $16,982.44 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,884.03 / $5,495.41
| Professional | | $2,041.74 | $2,884.03 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.66 / $100.00 / $9,332.54
| Facility | | $61.66 | $100.00 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,089.30 / $4,786.30
| Professional | | $1,445.44 | $2,089.30 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,778.28 / $4,073.80
| Professional | | $1,479.11 | $1,778.28 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,862.09 / $2,344.23
| Professional | | $1,513.56 | $1,862.09 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,659.59 / $2,691.53
| Professional | | $1,258.93 | $1,659.59 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $56.23 / $30,902.95
| Facility | | $54.95 | $56.23 | $30,902.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18,620.87 / $18,620.87 / $18,620.87
| Professional | | $18,620.87 | $18,620.87 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,137.96 / $2,137.96
| Professional | | $2,137.96 | $2,137.96 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,949.84 / $3,311.31
| Facility | | $1,548.82 | $1,949.84 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,819.70 / $4,073.80
| Professional | | $1,412.54 | $1,819.70 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,677.35 / $4,677.35 / $4,677.35
| Professional | | $4,677.35 | $4,677.35 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,630.27 / $3,981.07
| Professional | | $1,380.38 | $2,630.27 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $6,165.95 / $18,620.87
| Facility | | $2,041.74 | $6,165.95 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,737.80 / $3,801.89
| Professional | | $1,230.27 | $1,737.80 | $3,801.89 |