- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,105.36 / $2,105.36 / $8,147.74
| Facility | | $2,105.36 | $2,105.36 | $8,147.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,844.94 / $2,229.21 / $2,972.28
| Professional | | $1,844.94 | $2,229.21 | $2,972.28 |
- 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
- $3,589.85 / $4,714.47 / $4,714.47
| Professional | | $3,589.85 | $4,714.47 | $4,714.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,886.72 / $2,886.72 / $4,714.47
| Facility | | $2,886.72 | $2,886.72 | $4,714.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,107.31 / $2,107.31 / $4,128.16
| Professional | | $2,107.31 | $2,107.31 | $4,128.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,337.32 / $4,714.47 / $8,957.51
| Professional | | $4,337.32 | $4,714.47 | $8,957.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,183.45 / $3,183.45 / $3,300.14
| Professional | | $3,183.45 | $3,183.45 | $3,300.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,105.36 / $2,105.36 / $8,147.74
| Facility | | $2,105.36 | $2,105.36 | $8,147.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,844.94 / $2,229.21 / $3,831.76
| Professional | | $1,844.94 | $2,229.21 | $3,831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,845.40 / $6,722.20 / $9,288.40
| Professional | | $5,845.40 | $6,722.20 | $9,288.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,886.72 / $2,886.72 / $4,714.47
| Facility | | $2,886.72 | $2,886.72 | $4,714.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,107.31 / $2,107.31 / $5,599.88
| Professional | | $2,107.31 | $2,107.31 | $5,599.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,370.65 / $4,487.31 / $4,487.31
| Facility | | $3,370.65 | $4,487.31 | $4,487.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,370.65 / $4,487.31 / $4,597.54
| Professional | | $3,370.65 | $4,487.31 | $4,597.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,890.35 / $5,753.36 / $6,904.03
| Facility | | $4,890.35 | $5,753.36 | $6,904.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,125.77 / $2,657.21 / $4,251.54
| Professional | | $2,125.77 | $2,657.21 | $4,251.54 |