- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,882.25 / $1,882.25 / $7,284.31
| Facility | | $1,882.25 | $1,882.25 | $7,284.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,734.62 / $1,992.97 / $2,754.41
| Professional | | $1,734.62 | $1,992.97 | $2,754.41 |
- 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
- $3,209.42 / $4,214.88 / $4,214.88
| Professional | | $3,209.42 | $4,214.88 | $4,214.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,249.00 / $3,249.00 / $4,681.47
| Facility | | $3,249.00 | $3,249.00 | $4,681.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,371.77 / $2,371.77 / $4,099.27
| Professional | | $2,371.77 | $2,371.77 | $4,099.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,306.96 / $4,681.47 / $8,894.81
| Professional | | $4,306.96 | $4,681.47 | $8,894.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,882.25 / $1,882.25 / $7,284.31
| Facility | | $1,882.25 | $1,882.25 | $7,284.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,734.62 / $1,992.97 / $3,137.56
| Professional | | $1,734.62 | $1,992.97 | $3,137.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,170.90 / $6,384.90 / $9,223.40
| Professional | | $3,170.90 | $6,384.90 | $9,223.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,249.00 / $3,249.00 / $4,681.47
| Facility | | $3,249.00 | $3,249.00 | $4,681.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,371.77 / $2,371.77 / $5,990.63
| Professional | | $2,371.77 | $2,371.77 | $5,990.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,014.08 / $2,014.08 / $4,011.78
| Facility | | $2,014.08 | $2,014.08 | $4,011.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,014.08 / $4,011.78 / $4,455.91
| Professional | | $2,014.08 | $4,011.78 | $4,455.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,944.17 / $2,501.21 / $3,801.00
| Professional | | $1,944.17 | $2,501.21 | $3,801.00 |