- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $373.74 / $3,838.98 / $7,194.37
| Facility | | $373.74 | $3,838.98 | $7,194.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $247.43 / $317.24 / $706.89
| Professional | | $247.43 | $317.24 | $706.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.12 / $338.12 / $403.27
| Professional | | $338.12 | $338.12 | $403.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.59 / $532.79 / $709.50
| Professional | | $329.59 | $532.79 | $709.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.51 / $419.54 / $727.26
| Professional | | $282.51 | $419.54 | $727.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $250.95 / $363.88 / $634.88
| Facility | | $250.95 | $363.88 | $634.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $332.15 / $332.15 / $720.20
| Professional | | $332.15 | $332.15 | $720.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,801.61 / $7,801.61 / $7,801.61
| Facility | | $7,801.61 | $7,801.61 | $7,801.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $421.20 / $797.40
| Professional | | $3.00 | $421.20 | $797.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,526.00 / $7,659.00 / $10,502.00
| Facility | | $2,526.00 | $7,659.00 | $10,502.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.15 / $364.66 / $819.87
| Professional | | $252.15 | $364.66 | $819.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,285.16 / $1,285.16 / $20,000.00
| Facility | | $1,285.16 | $1,285.16 | $20,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,849.36 / $2,260.36 / $2,556.67
| Professional | | $1,849.36 | $2,260.36 | $2,556.67 |