- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,890.45 / $12,882.50
| Facility | | $1,000.00 | $3,890.45 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $602.56 / $977.24
| Professional | | $501.19 | $602.56 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $5,011.87 / $9,549.93
| Facility | | $2,884.03 | $5,011.87 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $630.96 / $870.96
| Professional | | $512.86 | $630.96 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $251.19 / $524.81
| Facility | | $251.19 | $251.19 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $2,398.83 / $2,398.83
| Facility | | $2,398.83 | $2,398.83 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $724.44 / $1,148.15
| Professional | | $549.54 | $724.44 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $42,657.95 / $42,657.95
| Facility | | $9,549.93 | $42,657.95 | $42,657.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,981.07 / $4,786.30 / $4,786.30
| Professional | | $3,981.07 | $4,786.30 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $977.24 / $5,495.41
| Facility | | $549.54 | $977.24 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $724.44 / $977.24
| Professional | | $512.86 | $724.44 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $457.09
| Professional | | $32.36 | $33.11 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.03 / $1,047.13 / $1,412.54
| Professional | | $6.03 | $1,047.13 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $707.95 / $1,230.27
| Facility | | $537.03 | $707.95 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $724.44 / $1,148.15
| Professional | | $524.81 | $724.44 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $5,248.07 / $10,964.78
| Facility | | $1,698.24 | $5,248.07 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $602.56 / $933.25
| Professional | | $436.52 | $602.56 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $562.34 / $562.34
| Professional | | $524.81 | $562.34 | $562.34 |