- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $692.14 / $692.14 / $2,678.58
| Facility | | $692.14 | $692.14 | $2,678.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $606.53 / $732.86 / $944.43
| Professional | | $606.53 | $732.86 | $944.43 |
- 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
- $1,180.17 / $1,549.90 / $1,549.90
| Professional | | $1,180.17 | $1,549.90 | $1,549.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $886.63 / $886.63 / $1,549.90
| Facility | | $886.63 | $886.63 | $1,549.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $647.24 / $647.24 / $1,357.14
| Professional | | $647.24 | $647.24 | $1,357.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,425.91 / $1,549.90 / $2,944.81
| Professional | | $1,425.91 | $1,549.90 | $2,944.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $692.14 / $692.14 / $2,678.58
| Facility | | $692.14 | $692.14 | $2,678.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $606.53 / $732.86 / $1,259.69
| Professional | | $606.53 | $732.86 | $1,259.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,921.70 / $2,209.90 / $3,053.60
| Professional | | $1,921.70 | $2,209.90 | $3,053.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $886.63 / $886.63 / $1,549.90
| Facility | | $886.63 | $886.63 | $1,549.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $647.24 / $647.24 / $1,840.88
| Professional | | $647.24 | $647.24 | $1,840.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,108.09 / $1,475.21 / $1,475.21
| Facility | | $1,108.09 | $1,475.21 | $1,475.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,108.09 / $1,475.21 / $1,511.46
| Professional | | $1,108.09 | $1,475.21 | $1,511.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.89 / $837.66 / $1,288.70
| Professional | | $707.89 | $837.66 | $1,288.70 |