- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,143.84 / $2,622.84 / $2,780.25
| Facility | | $1,143.84 | $2,622.84 | $2,780.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $864.21 / $1,019.58 / $1,190.34
| Professional | | $864.21 | $1,019.58 | $1,190.34 |
- 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
- $198.38 / $233.39 / $233.39
| Professional | | $198.38 | $233.39 | $233.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $978.75 / $1,097.34 / $1,871.41
| Facility | | $978.75 | $1,097.34 | $1,871.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $901.59 / $1,307.08 / $2,334.60
| Professional | | $901.59 | $1,307.08 | $2,334.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $415.93 / $2,542.21 / $3,606.45
| Professional | | $415.93 | $2,542.21 | $3,606.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,503.96 / $5,957.36 / $6,314.81
| Facility | | $2,503.96 | $5,957.36 | $6,314.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,143.84 / $2,622.84 / $6,040.77
| Facility | | $1,143.84 | $2,622.84 | $6,040.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $864.21 / $1,030.47 / $1,210.46
| Professional | | $864.21 | $1,030.47 | $1,210.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.51 / $369.27 / $1,450.28
| Professional | | $196.51 | $369.27 | $1,450.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $978.75 / $1,097.34 / $1,559.51
| Facility | | $978.75 | $1,097.34 | $1,559.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $901.59 / $1,291.66 / $2,366.27
| Professional | | $901.59 | $1,291.66 | $2,366.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $670.71 / $670.71 / $710.95
| Facility | | $670.71 | $670.71 | $710.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.08 / $684.12 / $710.95
| Professional | | $300.08 | $684.12 | $710.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.37 / $1,756.80 / $3,032.24
| Professional | | $676.37 | $1,756.80 | $3,032.24 |