- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $2,187.76 / $2,187.76
| Facility | | $933.25 | $2,187.76 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $630.96 / $758.58
| Professional | | $524.81 | $630.96 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $537.03 / $3,019.95
| Professional | | $457.09 | $537.03 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,511.89 / $4,073.80
| Facility | | $2,187.76 | $2,511.89 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,995.26 / $2,454.71
| Professional | | $912.01 | $1,995.26 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $3,311.31 / $5,011.87
| Facility | | $794.33 | $3,311.31 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,677.35 / $4,677.35 / $5,248.07
| Professional | | $4,677.35 | $4,677.35 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $954.99 / $2,754.23
| Facility | | $707.95 | $954.99 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $467.74 / $3,890.45
| Professional | | $354.81 | $467.74 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $64.57 / $70.79
| Professional | | $50.12 | $64.57 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,862.09 / $2,570.40
| Professional | | $1,258.93 | $1,862.09 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,715.35 / $3,715.35
| Facility | | $1,584.89 | $3,715.35 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $3,162.28 / $3,890.45
| Professional | | $1,148.15 | $3,162.28 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,659.59 / $1,659.59
| Professional | | $1,659.59 | $1,659.59 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,168.69 / $4,265.80 / $4,265.80
| Professional | | $4,168.69 | $4,265.80 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $630.96 / $954.99
| Facility | | $630.96 | $630.96 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $467.74 / $1,288.25
| Professional | | $331.13 | $467.74 | $1,288.25 |