- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $2,454.71 / $6,918.31
| Facility | | $549.54 | $2,454.71 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $371.54 / $588.84
| Professional | | $309.03 | $371.54 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $2,238.72 / $4,265.80
| Facility | | $1,288.25 | $2,238.72 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $407.38 / $562.34
| Professional | | $323.59 | $407.38 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.43 / $331.13 / $338.84
| Facility | | $79.43 | $331.13 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $457.09 / $724.44
| Professional | | $346.74 | $457.09 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $19,498.45 / $19,498.45
| Facility | | $4,786.30 | $19,498.45 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $3,235.94 / $3,235.94
| Professional | | $2,691.53 | $3,235.94 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $467.74 / $1,995.26
| Facility | | $338.84 | $467.74 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $467.74 / $707.95
| Professional | | $309.03 | $467.74 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $281.84 / $338.84
| Professional | | $32.36 | $281.84 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $1,258.93 / $1,479.11
| Professional | | $426.58 | $1,258.93 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $436.52 / $741.31
| Facility | | $331.13 | $436.52 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $457.09 / $724.44
| Professional | | $331.13 | $457.09 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $1,819.70 / $4,168.69
| Facility | | $436.52 | $1,819.70 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $363.08 / $549.54
| Professional | | $275.42 | $363.08 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $416.87 / $416.87
| Professional | | $389.05 | $416.87 | $416.87 |