- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $656.25 / $10,122.46 / $20,680.40
| Facility | | $656.25 | $10,122.46 | $20,680.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $656.25 / $656.25 / $1,377.86
| Professional | | $656.25 | $656.25 | $1,377.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,170.37 / $10,406.46 / $19,848.13
| Facility | | $6,170.37 | $10,406.46 | $19,848.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.45 / $1,720.50 / $1,720.50
| Professional | | $1,548.45 | $1,720.50 | $1,720.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $644.92 / $1,110.00 / $4,636.17
| Facility | | $644.92 | $1,110.00 | $4,636.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,346.48 / $3,596.22 / $9,525.34
| Facility | | $2,346.48 | $3,596.22 | $9,525.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,749.57 / $3,286.76 / $5,126.18
| Professional | | $1,749.57 | $3,286.76 | $5,126.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.00 / $50.00 / $80.00
| Professional | | $45.00 | $50.00 | $80.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,428.87 / $1,428.87 / $8,682.00
| Facility | | $1,428.87 | $1,428.87 | $8,682.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,313.10 / $1,961.22 / $1,961.22
| Facility | | $1,313.10 | $1,961.22 | $1,961.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,832.97 / $10,161.12 / $19,448.18
| Facility | | $6,832.97 | $10,161.12 | $19,448.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,634.48 / $1,720.50 / $1,720.50
| Professional | | $1,634.48 | $1,720.50 | $1,720.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.00 / $2,428.00 / $11,941.00
| Facility | | $1,403.00 | $2,428.00 | $11,941.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.15 / $211.15 / $211.15
| Professional | | $211.15 | $211.15 | $211.15 |