- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $405.60 / $1,659.34 / $4,134.39
| Facility | | $405.60 | $1,659.34 | $4,134.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $720.00 / $780.96 / $1,216.71
| Professional | | $720.00 | $780.96 | $1,216.71 |
- 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
- $1,349.65 / $1,400.58 / $1,400.58
| Professional | | $1,349.65 | $1,400.58 | $1,400.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $105.78 / $160.59 / $419.76
| Facility | | $105.78 | $160.59 | $419.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $519.54 / $519.54 / $649.44
| Professional | | $519.54 | $519.54 | $649.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,135.07 / $1,135.07 / $1,615.80
| Facility | | $1,135.07 | $1,135.07 | $1,615.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $405.60 / $1,538.49 / $4,134.39
| Facility | | $405.60 | $1,538.49 | $4,134.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $720.00 / $812.28 / $1,795.20
| Professional | | $720.00 | $812.28 | $1,795.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $105.78 / $210.43 / $431.80
| Facility | | $105.78 | $210.43 | $431.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $519.54 / $519.54 / $649.44
| Professional | | $519.54 | $519.54 | $649.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,297.50 / $1,297.50 / $1,297.50
| Facility | | $1,297.50 | $1,297.50 | $1,297.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,297.50 / $1,297.50 / $1,297.50
| Professional | | $1,297.50 | $1,297.50 | $1,297.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.37 / $18.37 / $18.37
| Facility | | $18.37 | $18.37 | $18.37 |