- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $521.00 / $2,172.00 / $7,316.00
| Facility | | $521.00 | $2,172.00 | $7,316.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $437.09 / $484.34 / $676.13
| Professional | | $437.09 | $484.34 | $676.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,422.96 / $4,678.74 / $9,190.95
| Facility | | $2,422.96 | $4,678.74 | $9,190.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $413.92 / $527.52 / $734.95
| Professional | | $413.92 | $527.52 | $734.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $413.75 / $413.75 / $413.75
| Facility | | $413.75 | $413.75 | $413.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,376.10 / $2,376.10 / $2,376.10
| Facility | | $2,376.10 | $2,376.10 | $2,376.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $471.91 / $611.63 / $944.15
| Professional | | $471.91 | $611.63 | $944.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,388.90 / $12,000.00 / $12,000.00
| Facility | | $9,388.90 | $12,000.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,352.08 / $3,428.88 / $3,831.60
| Professional | | $3,352.08 | $3,428.88 | $3,831.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.61 / $575.83 / $1,011.58
| Facility | | $446.61 | $575.83 | $1,011.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $581.55 / $684.45 / $805.23
| Professional | | $581.55 | $684.45 | $805.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $635.40 / $635.40 / $635.40
| Professional | | $635.40 | $635.40 | $635.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.61 / $581.74 / $1,161.86
| Facility | | $446.61 | $581.74 | $1,161.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $471.91 / $622.87 / $963.46
| Professional | | $471.91 | $622.87 | $963.46 |
- 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
- $381.10 / $524.02 / $809.85
| Professional | | $381.10 | $524.02 | $809.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $381.80 / $436.21 / $604.29
| Professional | | $381.80 | $436.21 | $604.29 |