- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $5,370.32 / $8,511.38
| Facility | | $1,047.13 | $5,370.32 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $812.83 / $2,238.72
| Professional | | $645.65 | $812.83 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $10,000.00 / $57,543.99
| Facility | | $9,549.93 | $10,000.00 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,230.27 / $1,230.27
| Professional | | $1,230.27 | $1,230.27 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,000.00 / $1,584.89
| Professional | | $758.58 | $1,000.00 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,122.02 / $1,288.25
| Professional | | $891.25 | $1,122.02 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $977.24 / $1,513.56
| Professional | | $724.44 | $977.24 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,848.93 / $15,848.93 / $15,848.93
| Facility | | $15,848.93 | $15,848.93 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $4,786.30 / $8,511.38
| Facility | | $977.24 | $4,786.30 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $954.99 / $2,398.83
| Professional | | $691.83 | $954.99 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $588.84 / $1,584.89
| Facility | | $588.84 | $588.84 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $1,258.93 / $1,659.59
| Professional | | $549.54 | $1,258.93 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $812.83 / $912.01
| Facility | | $812.83 | $812.83 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $812.83 / $912.01
| Professional | | $812.83 | $812.83 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $5,495.41 / $18,620.87
| Facility | | $2,454.71 | $5,495.41 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $891.25 / $1,584.89
| Professional | | $691.83 | $891.25 | $1,584.89 |