- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $657.55 / $1,495.41 / $1,764.58
| Facility | | $657.55 | $1,495.41 | $1,764.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.45 / $346.08 / $363.17
| Professional | | $226.45 | $346.08 | $363.17 |
- 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
- $333.26 / $333.26 / $333.26
| Professional | | $333.26 | $333.26 | $333.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $405.47 / $621.26 / $1,418.02
| Facility | | $405.47 | $621.26 | $1,418.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,059.39 / $2,059.39 / $2,059.39
| Professional | | $2,059.39 | $2,059.39 | $2,059.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $448.62 / $576.79 / $1,055.33
| Professional | | $448.62 | $576.79 | $1,055.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,161.81 / $1,764.58 / $1,764.58
| Facility | | $1,161.81 | $1,764.58 | $1,764.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.41 / $363.17 / $1,764.58
| Professional | | $280.41 | $363.17 | $1,764.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $415.91 / $661.42 / $1,418.02
| Facility | | $415.91 | $661.42 | $1,418.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,059.39 / $2,059.39 / $2,059.39
| Professional | | $2,059.39 | $2,059.39 | $2,059.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $427.26 / $427.26 / $469.99
| Facility | | $427.26 | $427.26 | $469.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $427.26 / $427.26 / $469.99
| Professional | | $427.26 | $427.26 | $469.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.45 / $256.36 / $598.16
| Professional | | $179.45 | $256.36 | $598.16 |