- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $267.12 / $430.08 / $3,551.11
| Facility | | $267.12 | $430.08 | $3,551.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.54 / $258.01 / $385.54
| Professional | | $215.54 | $258.01 | $385.54 |
- 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
- $232.60 / $241.37 / $533.50
| Professional | | $232.60 | $241.37 | $533.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $286.68 / $1,082.32 / $4,206.46
| Facility | | $286.68 | $1,082.32 | $4,206.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.72 / $314.19 / $541.86
| Professional | | $190.72 | $314.19 | $541.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.50 / $341.50 / $380.35
| Professional | | $341.50 | $341.50 | $380.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $267.12 / $488.83 / $1,345.12
| Facility | | $267.12 | $488.83 | $1,345.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.82 / $267.12 / $1,055.11
| Professional | | $224.82 | $267.12 | $1,055.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $286.68 / $951.20 / $4,206.46
| Facility | | $286.68 | $951.20 | $4,206.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.14 / $322.64 / $546.36
| Professional | | $196.14 | $322.64 | $546.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $210.50 / $240.36 / $240.36
| Facility | | $210.50 | $240.36 | $240.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.50 / $240.36 / $262.77
| Professional | | $210.50 | $240.36 | $262.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.60 / $313.23 / $494.90
| Professional | | $219.60 | $313.23 | $494.90 |