- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $579.00 / $2,496.00 / $7,495.00
| Facility | | $579.00 | $2,496.00 | $7,495.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.37 / $427.33 / $641.53
| Professional | | $178.37 | $427.33 | $641.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,613.85 / $4,640.32 / $9,691.79
| Facility | | $2,613.85 | $4,640.32 | $9,691.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.29 / $406.50 / $810.13
| Professional | | $165.29 | $406.50 | $810.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $152.16 / $152.16 / $152.16
| Facility | | $152.16 | $152.16 | $152.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,311.50 / $2,311.50 / $2,311.50
| Facility | | $2,311.50 | $2,311.50 | $2,311.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.34 / $519.79 / $872.80
| Professional | | $195.34 | $519.79 | $872.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $1,439.06
| Facility | | $55.00 | $55.00 | $1,439.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,924.99 / $3,661.36 / $4,306.50
| Professional | | $1,924.99 | $3,661.36 | $4,306.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.35 / $493.81 / $894.79
| Facility | | $177.35 | $493.81 | $894.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.33 / $544.39 / $890.82
| Professional | | $228.33 | $544.39 | $890.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $662.90 / $662.90 / $662.90
| Professional | | $662.90 | $662.90 | $662.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.35 / $496.08 / $1,098.85
| Facility | | $177.35 | $496.08 | $1,098.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.93 / $531.61 / $923.41
| Professional | | $198.93 | $531.61 | $923.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,154.00 / $3,314.00 / $7,600.00
| Facility | | $1,154.00 | $3,314.00 | $7,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $420.50 / $571.25 / $905.56
| Professional | | $420.50 | $571.25 | $905.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $422.38 / $472.88 / $670.82
| Professional | | $422.38 | $472.88 | $670.82 |