- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,012.80 / $1,063.44 / $1,063.44
| Facility | | $1,012.80 | $1,063.44 | $1,063.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $767.42 / $1,012.80 / $1,207.41
| Professional | | $767.42 | $1,012.80 | $1,207.41 |
- 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
- $179.17 / $1,581.00 / $1,791.70
| Professional | | $179.17 | $1,581.00 | $1,791.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.47 / $1,122.47 / $1,459.20
| Facility | | $1,122.47 | $1,122.47 | $1,459.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.57 / $1,122.47 / $2,077.50
| Professional | | $341.57 | $1,122.47 | $2,077.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,063.44 / $1,063.44 / $1,063.44
| Facility | | $1,063.44 | $1,063.44 | $1,063.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $764.55 / $956.73 / $1,147.83
| Professional | | $764.55 | $956.73 | $1,147.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.47 / $1,122.47 / $1,459.20
| Facility | | $1,122.47 | $1,122.47 | $1,459.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.57 / $1,122.47 / $2,596.88
| Professional | | $341.57 | $1,122.47 | $2,596.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,839.40 / $1,839.40 / $1,839.40
| Facility | | $1,839.40 | $1,839.40 | $1,839.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,839.40 / $1,839.40 / $1,839.40
| Professional | | $1,839.40 | $1,839.40 | $1,839.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $718.33 / $953.03 / $1,724.15
| Professional | | $718.33 | $953.03 | $1,724.15 |