- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,086.96 / $1,086.96 / $4,206.54
| Facility | | $1,086.96 | $1,086.96 | $4,206.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $952.33 / $1,210.97 / $1,470.81
| Professional | | $952.33 | $1,210.97 | $1,470.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,000.00 / $8,639.91 / $79,506.39
| Facility | | $5,000.00 | $8,639.91 | $79,506.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,011.11 / $2,641.15 / $2,641.15
| Professional | | $2,011.11 | $2,641.15 | $2,641.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,638.80 / $1,638.80 / $2,433.53
| Facility | | $1,638.80 | $1,638.80 | $2,433.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,196.32 / $1,196.32 / $2,937.00
| Professional | | $1,196.32 | $1,196.32 | $2,937.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.85 / $2,433.53 / $4,623.71
| Professional | | $2,238.85 | $2,433.53 | $4,623.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,086.96 / $1,086.96 / $4,206.54
| Facility | | $1,086.96 | $1,086.96 | $4,206.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $952.33 / $1,248.84 / $1,826.99
| Professional | | $952.33 | $1,248.84 | $1,826.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,648.30 / $3,319.00 / $4,794.50
| Professional | | $1,648.30 | $3,319.00 | $4,794.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,638.80 / $1,638.80 / $2,433.53
| Facility | | $1,638.80 | $1,638.80 | $2,433.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,196.32 / $1,196.32 / $2,937.00
| Professional | | $1,196.32 | $1,196.32 | $2,937.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,888.32 / $2,513.89 / $2,513.89
| Facility | | $1,888.32 | $2,513.89 | $2,513.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,888.32 / $2,513.89 / $2,513.89
| Professional | | $1,888.32 | $2,513.89 | $2,513.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $935.42 / $1,203.23 / $1,826.98
| Facility | | $935.42 | $1,203.23 | $1,826.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,017.56 / $1,317.65 / $2,381.81
| Professional | | $1,017.56 | $1,317.65 | $2,381.81 |