- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,818.38 / $8,912.51
| Facility | | $1,258.93 | $2,818.38 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,445.44 / $1,862.09
| Professional | | $1,174.90 | $1,445.44 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $1,949.84 / $1,949.84
| Professional | | $1,949.84 | $1,949.84 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.43 / $79.43 / $79.43
| Facility | | $79.43 | $79.43 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $3,630.78 / $7,762.47
| Facility | | $1,258.93 | $3,630.78 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,398.83 / $2,818.38
| Professional | | $1,023.29 | $2,398.83 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $9,332.54 / $9,332.54
| Facility | | $9,332.54 | $9,332.54 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,772.37 / $14,791.08 / $14,791.08
| Professional | | $9,772.37 | $14,791.08 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $2,041.74 / $3,890.45
| Facility | | $1,412.54 | $2,041.74 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,479.11 / $2,238.72
| Professional | | $1,174.90 | $1,479.11 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,089.30 / $4,168.69
| Professional | | $1,949.84 | $2,089.30 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $2,041.74 / $5,495.41
| Facility | | $1,318.26 | $2,041.74 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,137.96 / $3,388.44
| Professional | | $1,023.29 | $2,137.96 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $812.83 / $1,949.84
| Facility | | $707.95 | $812.83 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $812.83 / $1,202.26
| Professional | | $741.31 | $812.83 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,949.84 / $1,949.84
| Professional | | $691.83 | $1,949.84 | $1,949.84 |