- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,736.32 / $5,868.76 / $8,965.07
| Facility | | $1,736.32 | $5,868.76 | $8,965.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $517.89 / $1,736.32 / $2,057.86
| Professional | | $517.89 | $1,736.32 | $2,057.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,079.59 / $2,771.17 / $8,459.92
| Facility | | $2,079.59 | $2,771.17 | $8,459.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,475.38 / $1,672.01 / $1,672.01
| Professional | | $1,475.38 | $1,672.01 | $1,672.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,435.14 / $2,786.68 / $6,270.03
| Facility | | $1,435.14 | $2,786.68 | $6,270.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,128.60 / $2,420.09 / $4,848.58
| Professional | | $1,128.60 | $2,420.09 | $4,848.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $986.06 / $1,714.88 / $3,622.68
| Professional | | $986.06 | $1,714.88 | $3,622.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,635.08 / $1,635.08 / $1,635.08
| Facility | | $1,635.08 | $1,635.08 | $1,635.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,736.32 / $5,868.76 / $8,853.07
| Facility | | $1,736.32 | $5,868.76 | $8,853.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,286.16 / $1,736.32 / $8,853.07
| Professional | | $1,286.16 | $1,736.32 | $8,853.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,172.53 / $3,215.40 / $4,287.20
| Professional | | $3,172.53 | $3,215.40 | $4,287.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,497.88 / $3,318.10 / $7,114.00
| Facility | | $1,497.88 | $3,318.10 | $7,114.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,589.70 / $2,420.09 / $4,848.58
| Professional | | $1,589.70 | $2,420.09 | $4,848.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $709.78 / $2,143.60 / $2,143.60
| Facility | | $709.78 | $2,143.60 | $2,143.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $709.78 / $2,143.60 / $2,143.60
| Professional | | $709.78 | $2,143.60 | $2,143.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $361.26 / $1,190.05 / $3,001.04
| Professional | | $361.26 | $1,190.05 | $3,001.04 |