- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $356.40 / $1,204.63 / $1,840.19
| Facility | | $356.40 | $1,204.63 | $1,840.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.61 / $356.40 / $2,829.20
| Professional | | $106.61 | $356.40 | $2,829.20 |
- 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
- $343.20 / $343.20 / $343.20
| Professional | | $343.20 | $343.20 | $343.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $417.56 / $650.11 / $1,460.40
| Facility | | $417.56 | $650.11 | $1,460.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.99 / $406.28 / $995.34
| Professional | | $81.99 | $406.28 | $995.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.80 / $576.40 / $836.00
| Professional | | $261.80 | $576.40 | $836.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $374.00 / $1,204.63 / $1,817.20
| Facility | | $374.00 | $1,204.63 | $1,817.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.20 / $374.00 / $1,817.20
| Professional | | $277.20 | $374.00 | $1,817.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $651.20 / $660.00 / $880.00
| Professional | | $651.20 | $660.00 | $880.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $428.19 / $732.02 / $1,460.40
| Facility | | $428.19 | $732.02 | $1,460.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.80 / $416.32 / $995.34
| Professional | | $95.80 | $416.32 | $995.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $195.84 / $440.00 / $440.00
| Facility | | $195.84 | $440.00 | $440.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.84 / $440.00 / $440.00
| Professional | | $195.84 | $440.00 | $440.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.03 / $257.07 / $616.00
| Professional | | $159.03 | $257.07 | $616.00 |