- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $6,760.83 / $10,964.78
| Facility | | $3,715.35 | $6,760.83 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,311.31 / $6,456.54
| Professional | | $2,344.23 | $3,311.31 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $575.44 / $5,248.07
| Professional | | $575.44 | $575.44 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,890.45 / $3,890.45
| Facility | | $2,344.23 | $3,890.45 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $3,890.45 / $3,890.45
| Professional | | $2,818.38 | $3,890.45 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $8,317.64 / $10,000.00
| Facility | | $2,511.89 | $8,317.64 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $6,025.60 / $18,620.87
| Professional | | $2,344.23 | $6,025.60 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $6,456.54 / $14,791.08
| Facility | | $3,890.45 | $6,456.54 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $3,801.89 / $7,413.10
| Professional | | $2,691.53 | $3,801.89 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,311.31 / $3,801.89 / $6,918.31
| Professional | | $3,311.31 | $3,801.89 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $7,244.36 / $50,118.72
| Facility | | $5,011.87 | $7,244.36 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,890.45 / $3,890.45 / $3,981.07
| Professional | | $3,890.45 | $3,890.45 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $3,890.45 / $4,677.35
| Facility | | $3,467.37 | $3,890.45 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,344.23 / $5,128.61
| Professional | | $1,621.81 | $2,344.23 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $4,073.80 / $4,073.80
| Facility | | $3,311.31 | $4,073.80 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,311.31 / $3,890.45 / $9,332.54
| Professional | | $3,311.31 | $3,890.45 | $9,332.54 |