- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $3,090.30 / $7,762.47
| Facility | | $416.87 | $3,090.30 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $316.23 / $851.14
| Professional | | $234.42 | $316.23 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $3,630.78 / $5,011.87
| Facility | | $1,819.70 | $3,630.78 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $263.03 / $724.44
| Professional | | $208.93 | $263.03 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $1,258.93 / $4,073.80
| Facility | | $363.08 | $1,258.93 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $363.08 / $363.08
| Professional | | $363.08 | $363.08 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $562.34 / $50,118.72
| Facility | | $562.34 | $562.34 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $426.58 / $1,288.25
| Professional | | $257.04 | $426.58 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $380.19 / $912.01
| Facility | | $218.78 | $380.19 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $512.86 / $776.25
| Professional | | $380.19 | $512.86 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $302.00 / $302.00
| Facility | | $302.00 | $302.00 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $416.87 / $676.08
| Professional | | $257.04 | $416.87 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $50,118.72 / $75,857.76
| Facility | | $281.84 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $398.11 / $724.44
| Professional | | $316.23 | $398.11 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $3,311.31 / $6,165.95
| Facility | | $1,621.81 | $3,311.31 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $371.54 / $891.25
| Professional | | $229.09 | $371.54 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $371.54 / $1,230.27
| Facility | | $263.03 | $371.54 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $389.05 / $812.83
| Professional | | $263.03 | $389.05 | $812.83 |