- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $2,951.21 / $7,079.46
| Facility | | $707.95 | $2,951.21 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $457.09 / $741.31
| Professional | | $302.00 | $457.09 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $316.23 / $457.09
| Professional | | $316.23 | $316.23 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $4,365.16 / $8,511.38
| Facility | | $2,398.83 | $4,365.16 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $446.68 / $616.60
| Professional | | $302.00 | $446.68 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.43 / $309.03 / $309.03
| Facility | | $79.43 | $309.03 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $537.03 / $891.25
| Professional | | $354.81 | $537.03 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $28,840.32 / $28,840.32
| Facility | | $8,912.51 | $28,840.32 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,548.13 / $4,073.80 / $4,073.80
| Professional | | $3,548.13 | $4,073.80 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $549.54 / $2,454.71
| Facility | | $338.84 | $549.54 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $478.63 / $870.96
| Professional | | $302.00 | $478.63 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $302.00
| Professional | | $32.36 | $33.11 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $549.54 / $954.99
| Professional | | $549.54 | $549.54 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $512.86 / $870.96
| Facility | | $346.74 | $512.86 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $537.03 / $912.01
| Professional | | $338.84 | $537.03 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $4,073.80 / $8,912.51
| Facility | | $1,380.38 | $4,073.80 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $426.58 / $676.08
| Professional | | $288.40 | $426.58 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $501.19 / $501.19
| Professional | | $478.63 | $501.19 | $501.19 |