- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $986.10 / $986.10 / $3,816.21
| Facility | | $986.10 | $986.10 | $3,816.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $959.33 / $1,091.00 / $1,349.13
| Professional | | $959.33 | $1,091.00 | $1,349.13 |
- 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
- $1,824.49 / $2,396.07 / $2,396.07
| Professional | | $1,824.49 | $2,396.07 | $2,396.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,618.14 / $1,618.14 / $2,451.42
| Facility | | $1,618.14 | $1,618.14 | $2,451.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,181.24 / $1,181.24 / $2,146.55
| Professional | | $1,181.24 | $1,181.24 | $2,146.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,255.32 / $2,451.42 / $4,657.72
| Professional | | $2,255.32 | $2,451.42 | $4,657.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,677.25 / $1,677.25 / $1,677.25
| Professional | | $1,677.25 | $1,677.25 | $1,677.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $986.10 / $986.10 / $3,816.21
| Facility | | $986.10 | $986.10 | $3,816.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $959.33 / $1,132.96 / $1,554.26
| Professional | | $959.33 | $1,132.96 | $1,554.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,039.40 / $3,495.40 / $4,829.70
| Professional | | $3,039.40 | $3,495.40 | $4,829.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,618.14 / $1,618.14 / $2,451.42
| Facility | | $1,618.14 | $1,618.14 | $2,451.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,181.24 / $1,181.24 / $2,837.63
| Professional | | $1,181.24 | $1,181.24 | $2,837.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,713.09 / $2,280.61 / $2,280.61
| Facility | | $1,713.09 | $2,280.61 | $2,280.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,713.09 / $2,280.61 / $2,333.30
| Professional | | $1,713.09 | $2,280.61 | $2,333.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $922.24 / $1,195.36 / $1,992.29
| Professional | | $922.24 | $1,195.36 | $1,992.29 |