- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $563.16 / $1,090.53 / $2,455.67
| Facility | | $563.16 | $1,090.53 | $2,455.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $580.60 / $681.36 / $2,746.06
| Professional | | $580.60 | $681.36 | $2,746.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $504.33 / $978.37 / $1,222.96
| Professional | | $504.33 | $978.37 | $1,222.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,000.00 / $8,639.91 / $79,506.39
| Facility | | $5,000.00 | $8,639.91 | $79,506.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $648.16 / $672.63 / $1,164.68
| Professional | | $648.16 | $672.63 | $1,164.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $730.90 / $730.90 / $730.90
| Facility | | $730.90 | $730.90 | $730.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $516.75 / $776.23 / $1,242.00
| Professional | | $516.75 | $776.23 | $1,242.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $720.38 / $824.15 / $981.22
| Professional | | $720.38 | $824.15 | $981.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $697.04 / $739.46 / $1,169.92
| Professional | | $697.04 | $739.46 | $1,169.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $626.74 / $1,198.50 / $2,705.49
| Facility | | $626.74 | $1,198.50 | $2,705.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $581.22 / $725.40 / $1,861.41
| Professional | | $581.22 | $725.40 | $1,861.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $830.60 / $995.05 / $1,326.74
| Professional | | $830.60 | $995.05 | $1,326.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $730.90 / $730.90 / $730.90
| Facility | | $730.90 | $730.90 | $730.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $541.03 / $776.65 / $1,257.56
| Professional | | $541.03 | $776.65 | $1,257.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $629.67 / $629.67 / $680.53
| Facility | | $629.67 | $629.67 | $680.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $613.35 / $630.03 / $680.53
| Professional | | $613.35 | $630.03 | $680.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $583.70 / $728.87 / $1,205.76
| Professional | | $583.70 | $728.87 | $1,205.76 |