- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $3,019.95 / $7,413.10
| Facility | | $794.33 | $3,019.95 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $309.03 / $501.19
| Professional | | $257.04 | $309.03 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $6,760.83 / $12,882.50
| Facility | | $3,311.31 | $6,760.83 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $263.03 / $288.40
| Professional | | $251.19 | $263.03 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $239.88 / $239.88
| Facility | | $239.88 | $239.88 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $3,630.78 / $3,630.78
| Facility | | $3,630.78 | $3,630.78 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $371.54 / $588.84
| Professional | | $275.42 | $371.54 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,454.40 / $28,840.32 / $28,840.32
| Facility | | $14,454.40 | $28,840.32 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,290.87 / $2,290.87
| Professional | | $1,995.26 | $2,290.87 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $562.34 / $4,365.16
| Facility | | $269.15 | $562.34 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $338.84 / $446.68
| Professional | | $263.03 | $338.84 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $208.93
| Professional | | $32.36 | $33.11 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $575.44 / $676.08
| Professional | | $524.81 | $575.44 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $371.54 / $645.65
| Facility | | $257.04 | $371.54 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $371.54 / $575.44
| Professional | | $275.42 | $371.54 | $575.44 |
- 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
- $234.42 / $316.23 / $489.78
| Professional | | $234.42 | $316.23 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $257.04 / $257.04
| Professional | | $239.88 | $257.04 | $257.04 |