- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,281.42 / $1,281.42 / $4,959.10
| Facility | | $1,281.42 | $1,281.42 | $4,959.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,180.92 / $1,356.80 / $1,755.59
| Professional | | $1,180.92 | $1,356.80 | $1,755.59 |
- 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
- $2,184.94 / $2,869.45 / $2,869.45
| Professional | | $2,184.94 | $2,869.45 | $2,869.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,743.07 / $1,743.07 / $3,041.90
| Facility | | $1,743.07 | $1,743.07 | $3,041.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,272.44 / $1,272.44 / $3,818.25
| Professional | | $1,272.44 | $1,272.44 | $3,818.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,798.55 / $3,041.90 / $5,779.61
| Professional | | $2,798.55 | $3,041.90 | $5,779.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,937.61 / $1,937.61 / $1,937.61
| Professional | | $1,937.61 | $1,937.61 | $1,937.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,281.42 / $1,281.42 / $4,959.10
| Facility | | $1,281.42 | $1,281.42 | $4,959.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,180.92 / $1,356.80 / $2,136.37
| Professional | | $1,180.92 | $1,356.80 | $2,136.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,060.40 / $4,148.80 / $5,993.10
| Professional | | $2,060.40 | $4,148.80 | $5,993.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,743.07 / $1,743.07 / $3,041.90
| Facility | | $1,743.07 | $1,743.07 | $3,041.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,272.44 / $1,272.44 / $3,818.25
| Professional | | $1,272.44 | $1,272.44 | $3,818.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,371.18 / $1,371.18 / $2,731.19
| Facility | | $1,371.18 | $1,371.18 | $2,731.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,371.18 / $2,731.19 / $2,895.33
| Professional | | $1,371.18 | $2,731.19 | $2,895.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,342.11 / $1,642.24 / $2,587.69
| Professional | | $1,342.11 | $1,642.24 | $2,587.69 |