- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $4,466.84 / $5,495.41
| Facility | | $1,412.54 | $4,466.84 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $446.68 / $630.96
| Professional | | $263.03 | $446.68 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $3,981.07 / $10,000.00
| Facility | | $1,412.54 | $3,981.07 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $489.78 / $588.84
| Professional | | $407.38 | $489.78 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $398.11 / $512.86
| Professional | | $229.09 | $398.11 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $630.96 / $1,412.54
| Facility | | $269.15 | $630.96 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $426.58 / $630.96
| Professional | | $275.42 | $426.58 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $8,709.64 / $12,302.69
| Facility | | $6,918.31 | $8,709.64 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $501.19 / $616.60
| Professional | | $338.84 | $501.19 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $426.58 / $6,025.60
| Professional | | $229.09 | $426.58 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $9,332.54 / $18,197.01
| Facility | | $1,412.54 | $9,332.54 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $489.78 / $933.25
| Professional | | $309.03 | $489.78 | $933.25 |