- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $3,019.95 / $5,128.61
| Facility | | $537.03 | $3,019.95 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $707.95 / $2,238.72
| Professional | | $478.63 | $707.95 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $3,630.78 / $45,708.82
| Facility | | $1,348.96 | $3,630.78 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $891.25 / $2,089.30
| Professional | | $537.03 | $891.25 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $676.08 / $1,548.82
| Facility | | $676.08 | $676.08 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $1,258.93 / $1,949.84
| Professional | | $676.08 | $1,258.93 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $933.25 / $1,995.26
| Professional | | $602.56 | $933.25 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $1,122.02 / $7,079.46
| Facility | | $512.86 | $1,122.02 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $977.24 / $1,412.54
| Professional | | $758.58 | $977.24 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,630.78 / $8,511.38
| Facility | | $1,698.24 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $977.24 / $1,862.09
| Professional | | $602.56 | $977.24 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $4,073.80 / $4,786.30
| Facility | | $4,073.80 | $4,073.80 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,445.44 / $1,445.44
| Professional | | $1,445.44 | $1,445.44 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $3,630.78 / $45,708.82
| Facility | | $1,348.96 | $3,630.78 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $891.25 / $2,089.30
| Professional | | $537.03 | $891.25 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,630.78 / $8,511.38
| Facility | | $1,584.89 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $912.01 / $1,819.70
| Professional | | $575.44 | $912.01 | $1,819.70 |