- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $519.54 / $1,684.33 / $2,805.57
| Facility | | $519.54 | $1,684.33 | $2,805.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $378.00 / $495.73 / $610.16
| Professional | | $378.00 | $495.73 | $610.16 |
- 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
- $1,373.05 / $1,424.86 / $2,407.42
| Professional | | $1,373.05 | $1,424.86 | $2,407.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.22 / $734.91 / $1,837.49
| Facility | | $128.22 | $734.91 | $1,837.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.45 / $109.45 / $136.81
| Professional | | $109.45 | $109.45 | $136.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $648.42 / $923.06 / $3,772.80
| Facility | | $648.42 | $923.06 | $3,772.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $571.51 / $1,501.50 / $2,805.57
| Facility | | $571.51 | $1,501.50 | $2,805.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $378.00 / $478.11 / $797.50
| Professional | | $378.00 | $478.11 | $797.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.22 / $811.54 / $1,899.49
| Facility | | $128.22 | $811.54 | $1,899.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.45 / $109.45 / $136.81
| Professional | | $109.45 | $109.45 | $136.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,330.08 / $1,330.08 / $1,330.08
| Facility | | $1,330.08 | $1,330.08 | $1,330.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,330.08 / $1,330.08 / $1,330.08
| Professional | | $1,330.08 | $1,330.08 | $1,330.08 |