- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $1,479.11 / $3,630.78
| Facility | | $309.03 | $1,479.11 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $524.81 / $2,454.71
| Professional | | $181.97 | $524.81 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $954.99 / $2,818.38
| Facility | | $56.23 | $954.99 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $457.09 / $1,174.90
| Professional | | $204.17 | $457.09 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $218.78 / $512.86
| Facility | | $218.78 | $218.78 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $501.19 / $1,148.15
| Professional | | $281.84 | $501.19 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $446.68 / $1,023.29
| Professional | | $213.80 | $446.68 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.88 / $302.00 / $8,511.38
| Facility | | $154.88 | $302.00 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $562.34 / $794.33
| Professional | | $426.58 | $562.34 | $794.33 |
- 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
- $186.21 / $416.87 / $1,023.29
| Professional | | $186.21 | $416.87 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $1,174.90 / $1,479.11
| Facility | | $316.23 | $1,174.90 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $851.14 / $2,754.23
| Professional | | $660.69 | $851.14 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $954.99 / $2,818.38
| Facility | | $56.23 | $954.99 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $457.09 / $1,230.27
| Professional | | $204.17 | $457.09 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $645.65 / $831.76
| Professional | | $323.59 | $645.65 | $831.76 |
- 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
- $204.17 / $416.87 / $870.96
| Professional | | $204.17 | $416.87 | $870.96 |