- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $3,548.13 / $10,964.78
| Facility | | $1,819.70 | $3,548.13 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,905.46 / $4,570.88
| Professional | | $1,513.56 | $1,905.46 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $11,481.54 / $18,620.87
| Facility | | $4,786.30 | $11,481.54 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,659.59 / $4,168.69
| Professional | | $1,258.93 | $1,659.59 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,137.96 / $37,153.52
| Facility | | $2,137.96 | $2,137.96 | $37,153.52 |
- 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
- $34.67 / $2,630.27 / $53,703.18
| Facility | | $34.67 | $2,630.27 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,884.03 / $7,585.78
| Professional | | $1,513.56 | $2,884.03 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $3,162.28 / $5,754.40
| Facility | | $1,778.28 | $3,162.28 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,238.72 / $3,090.30
| Professional | | $1,584.89 | $2,238.72 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,778.28 / $2,818.38
| Professional | | $1,047.13 | $1,778.28 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $50,118.72 / $75,857.76
| Facility | | $1,737.80 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $1,995.26 / $2,454.71
| Professional | | $398.11 | $1,995.26 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $4,168.69 / $9,332.54
| Facility | | $1,513.56 | $4,168.69 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,995.26 / $4,570.88
| Professional | | $1,479.11 | $1,995.26 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,905.46 / $5,754.40
| Facility | | $1,230.27 | $1,905.46 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,905.46 / $5,754.40
| Professional | | $1,047.13 | $1,905.46 | $5,754.40 |