- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $902.00 / $907.64 / $6,344.46
| Facility | | $902.00 | $907.64 | $6,344.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $795.38 / $961.03 / $1,238.46
| Professional | | $795.38 | $961.03 | $1,238.46 |
- 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
- $1,547.62 / $2,032.46 / $2,032.46
| Professional | | $1,547.62 | $2,032.46 | $2,032.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,162.68 / $1,162.68 / $2,032.46
| Facility | | $1,162.68 | $1,162.68 | $2,032.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $988.28 / $988.28 / $1,779.69
| Professional | | $988.28 | $988.28 | $1,779.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,869.86 / $2,032.46 / $3,861.67
| Professional | | $1,869.86 | $2,032.46 | $3,861.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $326.75 / $326.75 / $326.75
| Facility | | $326.75 | $326.75 | $326.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48.04 / $907.64 / $6,867.37
| Facility | | $48.04 | $907.64 | $6,867.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $795.38 / $961.03 / $1,400.35
| Professional | | $795.38 | $961.03 | $1,400.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,520.00 / $2,898.00 / $4,004.30
| Professional | | $2,520.00 | $2,898.00 | $4,004.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,162.68 / $1,162.68 / $2,032.46
| Facility | | $1,162.68 | $1,162.68 | $2,032.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $988.28 / $988.28 / $2,414.25
| Professional | | $988.28 | $988.28 | $2,414.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,453.13 / $1,934.52 / $1,934.52
| Facility | | $1,453.13 | $1,934.52 | $1,934.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,453.13 / $1,934.52 / $1,982.04
| Professional | | $1,453.13 | $1,934.52 | $1,982.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $692.88 / $1,098.47 / $1,775.80
| Professional | | $692.88 | $1,098.47 | $1,775.80 |