- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,062.35 / $1,062.35 / $4,111.33
| Facility | | $1,062.35 | $1,062.35 | $4,111.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $817.07 / $1,124.84 / $1,316.33
| Professional | | $817.07 | $1,124.84 | $1,316.33 |
- 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
- $1,811.42 / $2,378.91 / $2,378.91
| Professional | | $1,811.42 | $2,378.91 | $2,378.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,606.19 / $1,606.19 / $2,087.90
| Facility | | $1,606.19 | $1,606.19 | $2,087.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,172.52 / $1,172.52 / $1,828.24
| Professional | | $1,172.52 | $1,172.52 | $1,828.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,920.87 / $2,087.90 / $3,967.01
| Professional | | $1,920.87 | $2,087.90 | $3,967.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,062.35 / $1,062.35 / $4,111.33
| Facility | | $1,062.35 | $1,062.35 | $4,111.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $817.07 / $1,124.84 / $1,933.50
| Professional | | $817.07 | $1,124.84 | $1,933.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,414.20 / $2,847.60 / $4,113.50
| Professional | | $1,414.20 | $2,847.60 | $4,113.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,606.19 / $1,606.19 / $2,087.90
| Facility | | $1,606.19 | $1,606.19 | $2,087.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,172.52 / $1,172.52 / $2,878.50
| Professional | | $1,172.52 | $1,172.52 | $2,878.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,136.77 / $1,136.77 / $2,264.28
| Facility | | $1,136.77 | $1,136.77 | $2,264.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,136.77 / $2,264.28 / $2,309.57
| Professional | | $1,136.77 | $2,264.28 | $2,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,041.63 / $1,350.11 / $2,087.90
| Professional | | $1,041.63 | $1,350.11 | $2,087.90 |