- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $383.27 / $1,555.92 / $1,885.83
| Facility | | $383.27 | $1,555.92 | $1,885.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $333.67 / $365.24 / $383.27
| Professional | | $333.67 | $365.24 | $383.27 |
- 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
- $351.71 / $351.71 / $351.71
| Professional | | $351.71 | $351.71 | $351.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $427.91 / $666.07 / $1,496.25
| Facility | | $427.91 | $666.07 | $1,496.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,173.39 / $2,173.39 / $2,173.39
| Professional | | $2,173.39 | $2,173.39 | $2,173.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $473.46 / $608.73 / $1,113.75
| Professional | | $473.46 | $608.73 | $1,113.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $464.44 / $1,280.11 / $1,862.26
| Facility | | $464.44 | $1,280.11 | $1,862.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.18 / $383.27 / $1,862.26
| Professional | | $338.18 | $383.27 | $1,862.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $667.35 / $676.37 / $901.82
| Professional | | $667.35 | $676.37 | $901.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $438.89 / $697.97 / $1,496.25
| Facility | | $438.89 | $697.97 | $1,496.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,173.39 / $2,173.39 / $2,173.39
| Professional | | $2,173.39 | $2,173.39 | $2,173.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $450.91 / $450.91 / $496.00
| Facility | | $450.91 | $450.91 | $496.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $450.91 / $450.91 / $496.00
| Professional | | $450.91 | $450.91 | $496.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.38 / $270.55 / $676.37
| Professional | | $189.38 | $270.55 | $676.37 |