- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,059.97 / $5,116.62 / $20,680.40
| Facility | | $1,059.97 | $5,116.62 | $20,680.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $550.61 / $747.78 / $1,510.27
| Professional | | $550.61 | $747.78 | $1,510.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,968.10 / $9,879.37 / $25,560.89
| Facility | | $5,968.10 | $9,879.37 | $25,560.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $801.13 / $1,352.48 / $9,677.00
| Professional | | $801.13 | $1,352.48 | $9,677.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,353.44 / $2,353.44 / $3,920.80
| Facility | | $2,353.44 | $2,353.44 | $3,920.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $721.27 / $1,192.73 / $1,759.88
| Professional | | $721.27 | $1,192.73 | $1,759.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $717.67 / $1,312.08 / $6,620.15
| Facility | | $717.67 | $1,312.08 | $6,620.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $717.78 / $1,283.46 / $2,641.65
| Professional | | $717.78 | $1,283.46 | $2,641.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.37 / $688.71 / $1,337.63
| Professional | | $99.37 | $688.71 | $1,337.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $819.50 / $1,119.57 / $1,166.47
| Facility | | $819.50 | $1,119.57 | $1,166.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $770.55 / $795.64 / $1,470.05
| Facility | | $770.55 | $795.64 | $1,470.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $818.97 / $1,327.16 / $1,631.84
| Professional | | $818.97 | $1,327.16 | $1,631.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,406.33 / $9,879.37 / $18,898.13
| Facility | | $6,406.33 | $9,879.37 | $18,898.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $785.86 / $1,141.98 / $1,541.66
| Professional | | $785.86 | $1,141.98 | $1,541.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,550.00 / $2,431.00 / $11,261.00
| Facility | | $1,550.00 | $2,431.00 | $11,261.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $735.68 / $1,210.65 / $1,657.76
| Professional | | $735.68 | $1,210.65 | $1,657.76 |