- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,492.81 / $2,492.81 / $9,647.17
| Facility | | $2,492.81 | $2,492.81 | $9,647.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,184.48 / $2,639.45 / $3,519.27
| Professional | | $2,184.48 | $2,639.45 | $3,519.27 |
- 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
- $4,250.50 / $5,582.09 / $5,582.09
| Professional | | $4,250.50 | $5,582.09 | $5,582.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,052.23 / $4,052.23 / $5,582.09
| Facility | | $4,052.23 | $4,052.23 | $5,582.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,958.13 / $2,958.13 / $4,887.87
| Professional | | $2,958.13 | $2,958.13 | $4,887.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,135.52 / $5,582.09 / $10,605.97
| Professional | | $5,135.52 | $5,582.09 | $10,605.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,769.31 / $3,769.31 / $3,769.31
| Professional | | $3,769.31 | $3,769.31 | $3,769.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,492.81 / $2,492.81 / $9,647.17
| Facility | | $2,492.81 | $2,492.81 | $9,647.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,184.48 / $2,737.21 / $4,536.91
| Professional | | $2,184.48 | $2,737.21 | $4,536.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,921.10 / $7,959.30 / $10,997.70
| Professional | | $6,921.10 | $7,959.30 | $10,997.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,052.23 / $4,052.23 / $5,582.09
| Facility | | $4,052.23 | $4,052.23 | $5,582.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,958.13 / $2,958.13 / $7,323.00
| Professional | | $2,958.13 | $2,958.13 | $7,323.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,990.96 / $5,313.12 / $5,313.12
| Facility | | $3,990.96 | $5,313.12 | $5,313.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,990.96 / $5,313.12 / $6,012.41
| Professional | | $3,990.96 | $5,313.12 | $6,012.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,606.42 / $3,087.76 / $4,918.96
| Professional | | $2,606.42 | $3,087.76 | $4,918.96 |