- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $3,235.94 / $7,762.47
| Facility | | $389.05 | $3,235.94 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $380.19 / $1,071.52
| Professional | | $229.09 | $380.19 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $389.05 / $512.86
| Professional | | $173.78 | $389.05 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,570.40 / $57,543.99
| Facility | | $2,344.23 | $2,570.40 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $724.44 / $724.44
| Professional | | $630.96 | $724.44 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $407.38 / $660.69
| Professional | | $275.42 | $407.38 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $645.65 / $707.95
| Professional | | $501.19 | $645.65 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $501.19 / $741.31
| Professional | | $338.84 | $501.19 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $1,778.28 / $3,090.30
| Facility | | $741.31 | $1,778.28 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $407.38 / $446.68
| Professional | | $338.84 | $407.38 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $2,818.38 / $7,413.10
| Facility | | $537.03 | $2,818.38 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $407.38 / $933.25
| Professional | | $251.19 | $407.38 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $416.87 / $416.87
| Professional | | $416.87 | $416.87 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $398.11 / $467.74
| Facility | | $269.15 | $398.11 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $407.38 / $478.63
| Professional | | $269.15 | $407.38 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $1,230.27 / $3,890.45
| Facility | | $223.87 | $1,230.27 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $380.19 / $645.65
| Professional | | $257.04 | $380.19 | $645.65 |