- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $1,023.29 / $1,023.29
| Facility | | $446.68 | $1,023.29 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $309.03 / $446.68
| Professional | | $263.03 | $309.03 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $131.83 / $1,318.26
| Professional | | $112.20 | $131.83 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,202.26 / $1,905.46
| Facility | | $1,023.29 | $1,202.26 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $954.99 / $1,174.90
| Professional | | $426.58 | $954.99 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $1,584.89 / $2,398.83
| Facility | | $416.87 | $1,584.89 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,238.72 / $2,511.89
| Professional | | $2,238.72 | $2,238.72 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $446.68 / $1,318.26
| Facility | | $338.84 | $446.68 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $223.87 / $1,862.09
| Professional | | $169.82 | $223.87 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $64.57 / $186.21
| Professional | | $50.12 | $64.57 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $891.25 / $1,230.27
| Professional | | $602.56 | $891.25 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,778.28 / $1,778.28
| Facility | | $758.58 | $1,778.28 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $1,513.56 / $1,862.09
| Professional | | $549.54 | $1,513.56 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $794.33 / $794.33
| Professional | | $794.33 | $794.33 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $2,041.74 / $2,884.03
| Professional | | $1,096.48 | $2,041.74 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $302.00 / $446.68
| Facility | | $302.00 | $302.00 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $223.87 / $616.60
| Professional | | $158.49 | $223.87 | $616.60 |