- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $405.44 / $2,500.00 / $7,495.00
| Facility | | $405.44 | $2,500.00 | $7,495.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.39 / $323.42 / $463.04
| Professional | | $249.39 | $323.42 | $463.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,492.38 / $7,130.28 / $14,454.58
| Facility | | $3,492.38 | $7,130.28 | $14,454.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.55 / $319.66 / $529.84
| Professional | | $238.55 | $319.66 | $529.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $222.88 / $222.88 / $319.39
| Facility | | $222.88 | $222.88 | $319.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,770.00 / $3,533.90 / $4,187.68
| Facility | | $1,770.00 | $3,533.90 | $4,187.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.39 / $381.75 / $603.40
| Professional | | $275.39 | $381.75 | $603.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.46 / $11,500.00 / $16,394.00
| Facility | | $1,778.46 | $11,500.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,880.56 / $2,372.00 / $2,766.53
| Professional | | $1,880.56 | $2,372.00 | $2,766.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $260.22 / $361.07 / $585.21
| Facility | | $260.22 | $361.07 | $585.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.84 / $430.02 / $575.24
| Professional | | $328.84 | $430.02 | $575.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $427.50 / $870.50
| Professional | | $5.00 | $427.50 | $870.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $261.33 / $363.84 / $706.14
| Facility | | $261.33 | $363.84 | $706.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.57 / $419.91 / $719.20
| Professional | | $282.57 | $419.91 | $719.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,190.00 / $3,239.00 / $7,600.00
| Facility | | $1,190.00 | $3,239.00 | $7,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.93 / $353.93 / $551.16
| Professional | | $256.93 | $353.93 | $551.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.75 / $318.83 / $431.96
| Professional | | $272.75 | $318.83 | $431.96 |