- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,544.16 / $1,544.16 / $5,975.90
| Facility | | $1,544.16 | $1,544.16 | $5,975.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,310.26 / $1,635.00 / $2,549.44
| Professional | | $1,310.26 | $1,635.00 | $2,549.44 |
- 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
- $2,632.95 / $3,457.80 / $3,457.80
| Professional | | $2,632.95 | $3,457.80 | $3,457.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,400.00 / $2,400.00 / $3,348.14
| Facility | | $2,400.00 | $2,400.00 | $3,348.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,752.00 / $1,752.00 / $2,931.75
| Professional | | $1,752.00 | $1,752.00 | $2,931.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,080.29 / $3,348.14 / $6,361.47
| Professional | | $3,080.29 | $3,348.14 | $6,361.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,420.46 / $2,701.41 / $2,766.24
| Professional | | $2,420.46 | $2,701.41 | $2,766.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,544.16 / $1,544.16 / $5,975.90
| Facility | | $1,544.16 | $1,544.16 | $5,975.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,310.25 / $1,695.54 / $2,733.48
| Professional | | $1,310.25 | $1,695.54 | $2,733.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,267.69 / $4,358.89 / $6,596.40
| Professional | | $2,267.69 | $4,358.89 | $6,596.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,400.00 / $2,400.00 / $3,348.14
| Facility | | $2,400.00 | $2,400.00 | $3,348.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,752.00 / $1,752.00 / $4,293.00
| Professional | | $1,752.00 | $1,752.00 | $4,293.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,391.11 / $2,391.11 / $3,291.19
| Facility | | $2,391.11 | $2,391.11 | $3,291.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,391.11 / $3,291.19 / $3,357.01
| Professional | | $2,391.11 | $3,291.19 | $3,357.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,559.14 / $1,926.32 / $3,041.97
| Professional | | $1,559.14 | $1,926.32 | $3,041.97 |