- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.67 / $1,230.67 / $4,762.68
| Facility | | $1,230.67 | $1,230.67 | $4,762.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,078.44 / $1,303.06 / $1,991.31
| Professional | | $1,078.44 | $1,303.06 | $1,991.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.31 / $2,066.84 / $2,066.84
| Professional | | $1,819.31 | $2,066.84 | $2,066.84 |
- 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
- $2,098.40 / $2,755.79 / $2,755.79
| Professional | | $2,098.40 | $2,755.79 | $2,755.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,721.98 / $1,721.98 / $2,755.79
| Facility | | $1,721.98 | $1,721.98 | $2,755.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,257.05 / $1,257.05 / $2,413.07
| Professional | | $1,257.05 | $1,257.05 | $2,413.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,535.33 / $2,755.79 / $5,236.00
| Professional | | $2,535.33 | $2,755.79 | $5,236.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,152.96 / $2,204.64 / $2,204.64
| Professional | | $2,152.96 | $2,204.64 | $2,204.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.67 / $1,230.67 / $4,762.68
| Facility | | $1,230.67 | $1,230.67 | $4,762.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,078.44 / $1,351.32 / $2,239.82
| Professional | | $1,078.44 | $1,351.32 | $2,239.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,416.80 / $3,929.40 / $5,429.40
| Professional | | $3,416.80 | $3,929.40 | $5,429.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,721.98 / $1,721.98 / $2,755.79
| Facility | | $1,721.98 | $1,721.98 | $2,755.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,257.05 / $1,257.05 / $3,749.63
| Professional | | $1,257.05 | $1,257.05 | $3,749.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,786.08 / $1,786.08 / $2,623.00
| Facility | | $1,786.08 | $1,786.08 | $2,623.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,786.08 / $2,623.00 / $2,675.46
| Professional | | $1,786.08 | $2,623.00 | $2,675.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,123.22 / $3,674.38 / $4,409.26
| Facility | | $3,123.22 | $3,674.38 | $4,409.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,313.54 / $1,614.72 / $2,428.42
| Professional | | $1,313.54 | $1,614.72 | $2,428.42 |