- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $2,691.53 / $5,128.61
| Facility | | $467.74 | $2,691.53 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $575.44 / $1,819.70
| Professional | | $323.59 | $575.44 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $3,162.28 / $28,840.32
| Facility | | $794.33 | $3,162.28 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $630.96 / $1,621.81
| Professional | | $354.81 | $630.96 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $398.11 / $912.01
| Facility | | $398.11 | $398.11 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $691.83 / $1,258.93
| Professional | | $398.11 | $691.83 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $676.08 / $1,318.26
| Professional | | $354.81 | $676.08 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $707.95 / $7,079.46
| Facility | | $323.59 | $707.95 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $812.83 / $1,071.52
| Professional | | $660.69 | $812.83 | $1,071.52 |
- 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
- $389.05 / $707.95 / $1,479.11
| Professional | | $389.05 | $707.95 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $2,884.03 / $2,884.03
| Facility | | $2,884.03 | $2,884.03 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $616.60 / $1,584.89
| Professional | | $346.74 | $616.60 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $3,162.28 / $28,840.32
| Facility | | $794.33 | $3,162.28 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $630.96 / $1,621.81
| Professional | | $354.81 | $630.96 | $1,621.81 |
- 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
- $380.19 / $676.08 / $1,445.44
| Professional | | $380.19 | $676.08 | $1,445.44 |