- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $652.54 / $652.54 / $2,525.37
| Facility | | $652.54 | $652.54 | $2,525.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $642.25 / $714.43 / $1,079.01
| Professional | | $642.25 | $714.43 | $1,079.01 |
- 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
- $1,112.66 / $1,461.23 / $1,461.23
| Professional | | $1,112.66 | $1,461.23 | $1,461.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $913.06 / $913.06 / $1,854.92
| Facility | | $913.06 | $913.06 | $1,854.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $666.53 / $666.53 / $1,624.24
| Professional | | $666.53 | $666.53 | $1,624.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,706.53 / $1,854.92 / $3,524.35
| Professional | | $1,706.53 | $1,854.92 | $3,524.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $986.70 / $986.70 / $986.70
| Professional | | $986.70 | $986.70 | $986.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $652.54 / $652.54 / $2,525.37
| Facility | | $652.54 | $652.54 | $2,525.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $639.75 / $716.52 / $1,169.45
| Professional | | $639.75 | $716.52 | $1,169.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,256.40 / $2,529.90 / $3,654.50
| Professional | | $1,256.40 | $2,529.90 | $3,654.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $913.06 / $913.06 / $1,854.92
| Facility | | $913.06 | $913.06 | $1,854.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $666.53 / $666.53 / $2,241.00
| Professional | | $666.53 | $666.53 | $2,241.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $698.25 / $698.25 / $1,390.82
| Facility | | $698.25 | $698.25 | $1,390.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $698.25 / $1,390.82 / $1,765.55
| Professional | | $698.25 | $1,390.82 | $1,765.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $683.45 / $878.72 / $1,317.74
| Professional | | $683.45 | $878.72 | $1,317.74 |