- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $2,238.72 / $3,801.89
| Facility | | $575.44 | $2,238.72 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $645.65 / $1,621.81
| Professional | | $524.81 | $645.65 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $2,398.83 / $19,498.45
| Facility | | $660.69 | $2,398.83 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $870.96 / $2,137.96
| Professional | | $524.81 | $870.96 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $707.95 / $1,584.89
| Facility | | $707.95 | $707.95 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,202.26 / $1,737.80
| Professional | | $741.31 | $1,202.26 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $954.99 / $1,698.24
| Professional | | $588.84 | $954.99 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $1,258.93 / $7,079.46
| Facility | | $380.19 | $1,258.93 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $977.24 / $1,318.26
| Professional | | $794.33 | $977.24 | $1,318.26 |
- 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
- $676.08 / $1,096.48 / $1,819.70
| Professional | | $676.08 | $1,096.48 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $588.84 / $3,388.44
| Facility | | $588.84 | $588.84 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $331.13 / $331.13
| Professional | | $331.13 | $331.13 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $2,398.83 / $19,498.45
| Facility | | $741.31 | $2,398.83 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $870.96 / $2,137.96
| Professional | | $537.03 | $870.96 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,041.74 / $4,073.80
| Facility | | $630.96 | $2,041.74 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $912.01 / $1,819.70
| Professional | | $602.56 | $912.01 | $1,819.70 |