- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $839.62 / $943.39 / $943.39
| Facility | | $839.62 | $943.39 | $943.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $458.36 / $839.62 / $943.39
| Professional | | $458.36 | $839.62 | $943.39 |
- 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
- $820.38 / $1,077.38 / $1,077.38
| Professional | | $820.38 | $1,077.38 | $1,077.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,396.46 / $1,396.46 / $1,396.46
| Facility | | $1,396.46 | $1,396.46 | $1,396.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $517.14 / $517.14 / $1,312.13
| Professional | | $517.14 | $517.14 | $1,312.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,279.75 / $1,391.03 / $2,642.96
| Professional | | $1,279.75 | $1,391.03 | $2,642.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,060.00 / $3,060.00 / $3,800.00
| Professional | | $3,060.00 | $3,060.00 | $3,800.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $943.39 / $943.39 / $943.39
| Facility | | $943.39 | $943.39 | $943.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $451.79 / $839.62 / $943.39
| Professional | | $451.79 | $839.62 | $943.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $942.10 / $1,811.00 / $2,740.60
| Professional | | $942.10 | $1,811.00 | $2,740.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,396.46 / $1,396.46 / $1,396.46
| Facility | | $1,396.46 | $1,396.46 | $1,396.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $517.14 / $517.14 / $1,325.25
| Professional | | $517.14 | $517.14 | $1,325.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $770.28 / $1,025.47 / $1,025.47
| Facility | | $770.28 | $1,025.47 | $1,025.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $770.28 / $1,025.47 / $1,324.01
| Professional | | $770.28 | $1,025.47 | $1,324.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $414.13 / $553.66 / $971.59
| Professional | | $414.13 | $553.66 | $971.59 |