- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,516.24 / $1,516.24 / $1,516.24
| Facility | | $1,516.24 | $1,516.24 | $1,516.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $972.92 / $1,187.72 / $1,516.24
| Professional | | $972.92 | $1,187.72 | $1,516.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.49 / $7.49 / $5,227.87
| Professional | | $7.49 | $7.49 | $5,227.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,922.52 / $1,922.52 / $1,922.52
| Facility | | $1,922.52 | $1,922.52 | $1,922.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,477.42 / $4,063.64 / $6,233.73
| Facility | | $3,477.42 | $4,063.64 | $6,233.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,495.25 / $3,402.43 / $3,866.40
| Professional | | $1,495.25 | $3,402.43 | $3,866.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $972.92 / $1,516.24 / $4,422.35
| Facility | | $972.92 | $1,516.24 | $4,422.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $972.92 / $1,516.24 / $4,422.35
| Facility | | $972.92 | $1,516.24 | $4,422.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $631.77 / $758.12 / $3,896.54
| Professional | | $631.77 | $758.12 | $3,896.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.00 / $70.00 / $85.00
| Professional | | $50.00 | $70.00 | $85.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $972.92 / $1,516.24 / $4,422.35
| Facility | | $972.92 | $1,516.24 | $4,422.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,109.23 / $3,012.70 / $4,225.51
| Professional | | $2,109.23 | $3,012.70 | $4,225.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,527.06 / $6,001.77 / $6,001.77
| Facility | | $2,527.06 | $6,001.77 | $6,001.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,054.12 / $5,054.12 / $6,292.38
| Professional | | $5,054.12 | $5,054.12 | $6,292.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.32 / $2,691.32 / $2,691.32
| Professional | | $2,691.32 | $2,691.32 | $2,691.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,898.87 / $6,898.87 / $6,898.87
| Professional | | $6,898.87 | $6,898.87 | $6,898.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $631.77 / $758.12 / $2,653.41
| Professional | | $631.77 | $758.12 | $2,653.41 |