- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.88 / $714.92 / $714.92
| Facility | | $680.88 | $714.92 | $714.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $505.66 / $753.66 / $995.06
| Professional | | $505.66 | $753.66 | $995.06 |
- 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
- $93.86 / $93.86 / $93.86
| Professional | | $93.86 | $93.86 | $93.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.00 / $64.00 / $1,017.80
| Facility | | $64.00 | $64.00 | $1,017.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $750.60 / $750.60 / $750.60
| Professional | | $750.60 | $750.60 | $750.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.85 / $155.85 / $155.85
| Professional | | $155.85 | $155.85 | $155.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $694.57 / $694.57 / $694.57
| Professional | | $694.57 | $694.57 | $694.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $714.92 / $714.92 / $714.92
| Facility | | $714.92 | $714.92 | $714.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.37 / $680.88 / $896.80
| Professional | | $92.37 | $680.88 | $896.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.00 / $64.00 / $1,017.80
| Facility | | $64.00 | $64.00 | $1,017.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $750.60 / $750.60 / $4,077.00
| Professional | | $750.60 | $750.60 | $4,077.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,236.00 / $1,236.00 / $1,236.00
| Facility | | $1,236.00 | $1,236.00 | $1,236.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,236.00 / $1,236.00 / $1,260.72
| Professional | | $1,236.00 | $1,236.00 | $1,260.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.85 / $88.90 / $591.15
| Professional | | $60.85 | $88.90 | $591.15 |