- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $740.02 / $740.02 / $2,863.88
| Facility | | $740.02 | $740.02 | $2,863.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $703.68 / $818.75 / $994.61
| Professional | | $703.68 | $818.75 | $994.61 |
- 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
- $1,369.19 / $1,798.13 / $1,798.13
| Professional | | $1,369.19 | $1,798.13 | $1,798.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,028.38 / $1,028.38 / $1,798.13
| Facility | | $1,028.38 | $1,028.38 | $1,798.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $750.72 / $750.72 / $2,135.63
| Professional | | $750.72 | $750.72 | $2,135.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,654.28 / $1,798.13 / $3,416.45
| Professional | | $1,654.28 | $1,798.13 | $3,416.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,214.19 / $1,214.19 / $1,348.60
| Professional | | $1,214.19 | $1,214.19 | $1,348.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $740.02 / $740.02 / $2,863.88
| Facility | | $740.02 | $740.02 | $2,863.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $703.68 / $850.24 / $1,157.42
| Professional | | $703.68 | $850.24 | $1,157.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,229.50 / $2,563.90 / $3,542.60
| Professional | | $2,229.50 | $2,563.90 | $3,542.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,028.38 / $1,028.38 / $1,798.13
| Facility | | $1,028.38 | $1,028.38 | $1,798.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $750.72 / $750.72 / $2,135.63
| Professional | | $750.72 | $750.72 | $2,135.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,285.58 / $1,711.49 / $1,711.49
| Facility | | $1,285.58 | $1,711.49 | $1,711.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,285.58 / $1,711.49 / $1,753.55
| Professional | | $1,285.58 | $1,711.49 | $1,753.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $688.17 / $897.07 / $1,571.07
| Professional | | $688.17 | $897.07 | $1,571.07 |