- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.32 / $1,071.32 / $4,146.01
| Facility | | $1,071.32 | $1,071.32 | $4,146.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $894.28 / $1,134.33 / $1,544.30
| Professional | | $894.28 | $1,134.33 | $1,544.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,039.12 / $2,039.12 / $2,039.12
| Professional | | $2,039.12 | $2,039.12 | $2,039.12 |
- 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
- $1,826.70 / $2,398.96 / $2,398.96
| Professional | | $1,826.70 | $2,398.96 | $2,398.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,800.00 / $1,800.00 / $2,285.19
| Facility | | $1,800.00 | $1,800.00 | $2,285.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,314.00 / $1,314.00 / $2,110.78
| Professional | | $1,314.00 | $1,314.00 | $2,110.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,102.37 / $2,285.19 / $4,341.85
| Professional | | $2,102.37 | $2,285.19 | $4,341.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,679.28 / $1,679.28 / $1,769.54
| Professional | | $1,679.28 | $1,679.28 | $1,769.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.32 / $1,071.32 / $4,146.01
| Facility | | $1,071.32 | $1,071.32 | $4,146.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $894.27 / $1,176.33 / $1,919.18
| Professional | | $894.27 | $1,176.33 | $1,919.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,547.80 / $3,116.70 / $4,502.20
| Professional | | $1,547.80 | $3,116.70 | $4,502.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,800.00 / $1,800.00 / $2,285.19
| Facility | | $1,800.00 | $1,800.00 | $2,285.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,314.00 / $1,314.00 / $3,430.50
| Professional | | $1,314.00 | $1,314.00 | $3,430.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.34 / $1,146.34 / $2,283.37
| Facility | | $1,146.34 | $1,146.34 | $2,283.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,146.34 / $2,283.37 / $2,329.04
| Professional | | $1,146.34 | $2,283.37 | $2,329.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,104.48 / $1,296.56 / $2,096.03
| Professional | | $1,104.48 | $1,296.56 | $2,096.03 |