- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $6,606.93 / $9,772.37
| Facility | | $1,412.54 | $6,606.93 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,380.38 / $3,090.30
| Professional | | $1,148.15 | $1,380.38 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,417.38 / $21,379.62 / $57,543.99
| Facility | | $20,417.38 | $21,379.62 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,819.70 / $1,949.84
| Professional | | $1,258.93 | $1,819.70 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $794.33 / $2,187.76
| Facility | | $501.19 | $794.33 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,445.44 / $2,691.53
| Professional | | $954.99 | $1,445.44 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $2,691.53 / $2,691.53
| Facility | | $2,691.53 | $2,691.53 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,778.28 / $2,454.71
| Professional | | $1,318.26 | $1,778.28 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,318.26 / $2,137.96
| Professional | | $1,096.48 | $1,318.26 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $5,370.32 / $9,772.37
| Facility | | $1,122.02 | $5,370.32 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,659.59 / $3,801.89
| Professional | | $1,174.90 | $1,659.59 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,445.44 / $2,570.40
| Facility | | $1,174.90 | $1,445.44 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $2,238.72 / $2,691.53
| Professional | | $1,174.90 | $2,238.72 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,288.25 / $1,288.25
| Facility | | $1,258.93 | $1,288.25 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,258.93 / $1,318.26
| Professional | | $1,202.26 | $1,258.93 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $2,089.30 / $6,309.57
| Facility | | $316.23 | $2,089.30 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,380.38 / $2,290.87
| Professional | | $1,023.29 | $1,380.38 | $2,290.87 |