- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,503.17 / $2,650.42 / $18,939.78
| Facility | | $2,503.17 | $2,650.42 | $18,939.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,193.55 / $2,650.42 / $3,415.53
| Professional | | $2,193.55 | $2,650.42 | $3,415.53 |
- 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
- $4,268.14 / $5,605.27 / $5,605.27
| Professional | | $4,268.14 | $5,605.27 | $5,605.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,536.46 / $4,536.46 / $5,605.27
| Facility | | $4,536.46 | $4,536.46 | $5,605.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,855.99 / $3,855.99 / $4,908.18
| Professional | | $3,855.99 | $3,855.99 | $4,908.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,156.85 / $5,605.27 / $10,650.01
| Professional | | $5,156.85 | $5,605.27 | $10,650.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,773.28 / $7,773.28 / $7,773.28
| Facility | | $7,773.28 | $7,773.28 | $7,773.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,503.17 / $8,592.54 / $30,768.89
| Facility | | $2,503.17 | $8,592.54 | $30,768.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,193.55 / $2,650.42 / $3,861.92
| Professional | | $2,193.55 | $2,650.42 | $3,861.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,949.80 / $7,992.30 / $11,043.40
| Professional | | $6,949.80 | $7,992.30 | $11,043.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,536.46 / $4,536.46 / $5,605.27
| Facility | | $4,536.46 | $4,536.46 | $5,605.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,855.99 / $3,855.99 / $6,657.75
| Professional | | $3,855.99 | $3,855.99 | $6,657.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,007.54 / $5,335.19 / $5,335.19
| Facility | | $4,007.54 | $5,335.19 | $5,335.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,007.54 / $5,335.19 / $5,466.16
| Professional | | $4,007.54 | $5,335.19 | $5,466.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,560.09 / $3,159.29 / $5,054.87
| Professional | | $2,560.09 | $3,159.29 | $5,054.87 |