- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $2,818.38 / $4,897.79
| Facility | | $363.08 | $2,818.38 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $549.54 / $1,548.82
| Professional | | $263.03 | $549.54 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,659.59 / $45,708.82
| Facility | | $676.08 | $1,659.59 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $575.44 / $1,380.38
| Professional | | $331.13 | $575.44 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $354.81 / $812.83
| Facility | | $354.81 | $354.81 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $676.08 / $1,230.27
| Professional | | $416.87 | $676.08 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $660.69 / $1,258.93
| Professional | | $380.19 | $660.69 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $575.44 / $7,079.46
| Facility | | $257.04 | $575.44 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $645.65 / $912.01
| Professional | | $489.78 | $645.65 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,041.74 / $3,467.37
| Facility | | $630.96 | $2,041.74 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $562.34 / $1,174.90
| Professional | | $302.00 | $562.34 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $977.24 / $4,466.84
| Facility | | $436.52 | $977.24 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $446.68 / $776.25
| Professional | | $380.19 | $446.68 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,659.59 / $45,708.82
| Facility | | $707.95 | $1,659.59 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $575.44 / $1,412.54
| Professional | | $331.13 | $575.44 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $363.08 / $537.03
| Professional | | $208.93 | $363.08 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,819.70 / $2,818.38
| Facility | | $575.44 | $1,819.70 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $602.56 / $1,096.48
| Professional | | $338.84 | $602.56 | $1,096.48 |