- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,300.14 / $1,365.15 / $1,365.15
| Facility | | $1,300.14 | $1,365.15 | $1,365.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $843.91 / $1,300.14 / $1,625.18
| Professional | | $843.91 | $1,300.14 | $1,625.18 |
- 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
- $1,889.52 / $2,484.60 / $2,484.60
| Professional | | $1,889.52 | $2,484.60 | $2,484.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.19 / $144.19 / $211.75
| Facility | | $144.19 | $144.19 | $211.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.56 / $144.19 / $3,689.06
| Professional | | $122.56 | $144.19 | $3,689.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,863.45 / $1,863.45 / $1,863.45
| Professional | | $1,863.45 | $1,863.45 | $1,863.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,365.15 / $1,365.15 / $1,365.15
| Facility | | $1,365.15 | $1,365.15 | $1,365.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $843.91 / $1,300.14 / $1,669.20
| Professional | | $843.91 | $1,300.14 | $1,669.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.19 / $144.19 / $211.75
| Facility | | $144.19 | $144.19 | $211.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.56 / $144.19 / $3,689.06
| Professional | | $122.56 | $144.19 | $3,689.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,361.90 / $2,361.90 / $2,361.90
| Facility | | $2,361.90 | $2,361.90 | $2,361.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,293.00 / $2,361.90 / $2,361.90
| Professional | | $2,293.00 | $2,361.90 | $2,361.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $782.57 / $901.16 / $1,845.33
| Professional | | $782.57 | $901.16 | $1,845.33 |