- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $6,309.57 / $11,481.54
| Facility | | $645.65 | $6,309.57 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $537.03 / $851.14
| Professional | | $338.84 | $537.03 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $323.59 / $323.59
| Professional | | $323.59 | $323.59 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $9,120.11 / $17,782.79
| Facility | | $6,918.31 | $9,120.11 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $562.34 / $812.83
| Professional | | $331.13 | $562.34 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $831.76 / $1,096.48
| Professional | | $371.54 | $831.76 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $758.58 / $9,772.37
| Facility | | $363.08 | $758.58 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $741.31 / $2,818.38
| Professional | | $457.09 | $741.31 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $831.76 / $1,148.15
| Professional | | $812.83 | $831.76 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $812.83 / $812.83
| Professional | | $812.83 | $812.83 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.03 / $660.69 / $954.99
| Professional | | $6.03 | $660.69 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $8,128.31 / $10,000.00
| Facility | | $6,918.31 | $8,128.31 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $676.08 / $912.01
| Professional | | $467.74 | $676.08 | $912.01 |