- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $2,187.76 / $3,715.35
| Facility | | $331.13 | $2,187.76 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $426.58 / $1,258.93
| Professional | | $302.00 | $426.58 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,047.13 / $3,890.45
| Facility | | $56.23 | $1,047.13 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $630.96 / $1,318.26
| Professional | | $346.74 | $630.96 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $436.52 / $977.24
| Facility | | $436.52 | $436.52 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $831.76 / $1,230.27
| Professional | | $489.78 | $831.76 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $602.56 / $1,288.25
| Professional | | $416.87 | $602.56 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $501.19 / $7,079.46
| Facility | | $177.83 | $501.19 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $616.60 / $870.96
| Professional | | $467.74 | $616.60 | $870.96 |
- 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
- $371.54 / $602.56 / $1,148.15
| Professional | | $371.54 | $602.56 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $602.56
| Facility | | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $741.31 / $741.31
| Professional | | $741.31 | $741.31 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,047.13 / $3,890.45
| Facility | | $56.23 | $1,047.13 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $616.60 / $1,348.96
| Professional | | $346.74 | $616.60 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,862.09 / $2,818.38
| Facility | | $630.96 | $1,862.09 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $630.96 / $1,122.02
| Professional | | $398.11 | $630.96 | $1,122.02 |