- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $494.00 / $2,236.00 / $7,316.00
| Facility | | $494.00 | $2,236.00 | $7,316.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.45 / $322.02 / $470.55
| Professional | | $280.45 | $322.02 | $470.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,971.06 / $3,663.85 / $7,791.11
| Facility | | $1,971.06 | $3,663.85 | $7,791.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.77 / $374.41 / $521.63
| Professional | | $293.77 | $374.41 | $521.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $277.41 / $277.41 / $277.41
| Facility | | $277.41 | $277.41 | $277.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,725.26 / $1,725.26 / $1,725.26
| Facility | | $1,725.26 | $1,725.26 | $1,725.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.83 / $425.86 / $652.85
| Professional | | $318.83 | $425.86 | $652.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,817.20 / $12,000.00 / $12,000.00
| Facility | | $6,817.20 | $12,000.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,307.28 / $2,379.44 / $2,702.18
| Professional | | $2,307.28 | $2,379.44 | $2,702.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $298.32 / $395.30 / $674.65
| Facility | | $298.32 | $395.30 | $674.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $343.00 / $477.08 / $579.99
| Professional | | $343.00 | $477.08 | $579.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.70 / $226.70 / $226.70
| Professional | | $226.70 | $226.70 | $226.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $298.32 / $400.88 / $816.02
| Facility | | $298.32 | $400.88 | $816.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $320.93 / $435.93 / $675.51
| Professional | | $320.93 | $435.93 | $675.51 |
- 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
- $252.97 / $352.49 / $553.37
| Professional | | $252.97 | $352.49 | $553.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.13 / $303.58 / $419.93
| Professional | | $266.13 | $303.58 | $419.93 |