- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,062.21 / $1,062.21 / $4,110.75
| Facility | | $1,062.21 | $1,062.21 | $4,110.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $930.83 / $1,124.70 / $1,527.83
| Professional | | $930.83 | $1,124.70 | $1,527.83 |
- 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
- $1,811.18 / $2,378.58 / $2,378.58
| Professional | | $1,811.18 | $2,378.58 | $2,378.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,486.28 / $1,486.28 / $2,378.58
| Facility | | $1,486.28 | $1,486.28 | $2,378.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,084.98 / $1,084.98 / $2,082.77
| Professional | | $1,084.98 | $1,084.98 | $2,082.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,188.29 / $2,378.58 / $4,519.30
| Professional | | $2,188.29 | $2,378.58 | $4,519.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,606.13 / $1,606.13 / $1,783.94
| Professional | | $1,606.13 | $1,606.13 | $1,783.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,062.21 / $1,062.21 / $4,110.75
| Facility | | $1,062.21 | $1,062.21 | $4,110.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $930.83 / $1,124.70 / $1,811.18
| Professional | | $930.83 | $1,124.70 | $1,811.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,611.10 / $3,244.10 / $4,686.20
| Professional | | $1,611.10 | $3,244.10 | $4,686.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,486.28 / $1,486.28 / $2,378.58
| Facility | | $1,486.28 | $1,486.28 | $2,378.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,084.98 / $1,084.98 / $3,511.13
| Professional | | $1,084.98 | $1,084.98 | $3,511.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,136.61 / $1,136.61 / $2,263.96
| Facility | | $1,136.61 | $1,136.61 | $2,263.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,136.61 / $2,263.96 / $2,309.25
| Professional | | $1,136.61 | $2,263.96 | $2,309.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,428.89 / $1,428.89 / $1,428.89
| Facility | | $1,428.89 | $1,428.89 | $1,428.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,116.99 / $1,427.15 / $2,378.58
| Professional | | $1,116.99 | $1,427.15 | $2,378.58 |