- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.92 / $2,561.28 / $3,104.35
| Facility | | $630.92 | $2,561.28 | $3,104.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $445.36 / $601.24 / $630.92
| Professional | | $445.36 | $601.24 | $630.92 |
- 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
- $578.97 / $578.97 / $578.97
| Professional | | $578.97 | $578.97 | $578.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $496.95 / $964.96 / $2,463.33
| Facility | | $496.95 | $964.96 | $2,463.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,577.74 / $3,577.74 / $3,577.74
| Professional | | $3,577.74 | $3,577.74 | $3,577.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $779.38 / $1,002.06 / $1,833.41
| Professional | | $779.38 | $1,002.06 | $1,833.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $764.54 / $2,107.31 / $3,065.58
| Facility | | $764.54 | $2,107.31 | $3,065.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $487.15 / $630.92 / $3,065.58
| Professional | | $487.15 | $630.92 | $3,065.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,098.56 / $1,113.40 / $1,484.54
| Professional | | $1,098.56 | $1,113.40 | $1,484.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $496.95 / $964.96 / $2,463.33
| Facility | | $496.95 | $964.96 | $2,463.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,577.74 / $3,577.74 / $3,577.74
| Professional | | $3,577.74 | $3,577.74 | $3,577.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $742.27 / $742.27 / $816.50
| Facility | | $742.27 | $742.27 | $816.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $742.27 / $742.27 / $816.50
| Professional | | $742.27 | $742.27 | $816.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.75 / $445.36 / $1,358.35
| Professional | | $311.75 | $445.36 | $1,358.35 |