- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $182.23 / $300.83 / $1,025.46
| Facility | | $182.23 | $300.83 | $1,025.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.11 / $182.23 / $252.62
| Professional | | $148.11 | $182.23 | $252.62 |
- 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
- $162.69 / $168.84 / $389.75
| Professional | | $162.69 | $168.84 | $389.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $180.57 / $594.79 / $1,213.41
| Facility | | $180.57 | $594.79 | $1,213.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.96 / $219.97 / $369.66
| Professional | | $133.96 | $219.97 | $369.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.23 / $236.23 / $263.06
| Professional | | $236.23 | $236.23 | $263.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $598.53 / $598.53 / $598.53
| Facility | | $598.53 | $598.53 | $598.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $182.23 / $333.48 / $719.81
| Facility | | $182.23 | $333.48 | $719.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.76 / $183.00 / $719.81
| Professional | | $154.76 | $183.00 | $719.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $180.57 / $578.42 / $1,213.41
| Facility | | $180.57 | $578.42 | $1,213.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.10 / $225.06 / $384.28
| Professional | | $136.10 | $225.06 | $384.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.50 / $166.70 / $166.70
| Facility | | $162.50 | $166.70 | $166.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.50 / $166.70 / $181.25
| Professional | | $162.50 | $166.70 | $181.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.34 / $223.76 / $390.59
| Professional | | $168.34 | $223.76 | $390.59 |