- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $4,073.80 / $11,481.54
| Facility | | $2,089.30 | $4,073.80 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,089.30 / $5,888.44
| Professional | | $1,621.81 | $2,089.30 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $11,481.54 / $19,054.61
| Facility | | $4,897.79 | $11,481.54 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,949.84 / $5,370.32
| Professional | | $1,548.82 | $1,949.84 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $2,630.27 / $37,153.52
| Facility | | $2,630.27 | $2,630.27 | $37,153.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $2,630.27 / $2,630.27
| Professional | | $2,630.27 | $2,630.27 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $3,235.94 / $50,118.72
| Facility | | $34.67 | $3,235.94 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,090.30 / $9,332.54
| Professional | | $1,584.89 | $3,090.30 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $3,801.89 / $7,413.10
| Facility | | $2,041.74 | $3,801.89 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,754.23 / $3,715.35
| Professional | | $2,089.30 | $2,754.23 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,398.83 / $4,677.35
| Professional | | $1,380.38 | $2,398.83 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $50,118.72 / $75,857.76
| Facility | | $1,659.59 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $2,570.40 / $3,981.07
| Professional | | $398.11 | $2,570.40 | $3,981.07 |
- 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
- $1,778.28 / $2,570.40 / $6,606.93
| Professional | | $1,778.28 | $2,570.40 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,137.96 / $5,754.40
| Facility | | $1,513.56 | $2,137.96 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,238.72 / $4,677.35
| Professional | | $1,380.38 | $2,238.72 | $4,677.35 |