- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $4,786.30 / $8,317.64
| Facility | | $891.25 | $4,786.30 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $489.78 / $977.24
| Professional | | $323.59 | $489.78 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $10,000.00 / $57,543.99
| Facility | | $9,549.93 | $10,000.00 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $489.78 / $524.81
| Professional | | $489.78 | $489.78 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $588.84 / $588.84
| Facility | | $588.84 | $588.84 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $537.03 / $912.01
| Professional | | $346.74 | $537.03 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $812.83 / $1,023.29
| Professional | | $588.84 | $812.83 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $588.84 / $933.25
| Professional | | $346.74 | $588.84 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $354.81 / $354.81
| Professional | | $354.81 | $354.81 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $3,801.89 / $8,317.64
| Facility | | $954.99 | $3,801.89 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $575.44 / $1,412.54
| Professional | | $346.74 | $575.44 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $588.84 / $1,047.13
| Facility | | $588.84 | $588.84 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $660.69 / $1,148.15
| Professional | | $630.96 | $660.69 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $478.63 / $575.44
| Facility | | $338.84 | $478.63 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $478.63 / $512.86
| Professional | | $338.84 | $478.63 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $5,495.41 / $22,387.21
| Facility | | $2,454.71 | $5,495.41 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $512.86 / $851.14
| Professional | | $346.74 | $512.86 | $851.14 |