- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $3,630.78 / $7,244.36
| Facility | | $562.34 | $3,630.78 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $457.09 / $1,479.11
| Professional | | $302.00 | $457.09 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $323.59 / $346.74
| Professional | | $162.18 | $323.59 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $6,165.95 / $57,543.99
| Facility | | $5,011.87 | $6,165.95 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $478.63 / $616.60
| Professional | | $354.81 | $478.63 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $588.84 / $588.84
| Facility | | $588.84 | $588.84 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $426.58 / $707.95
| Professional | | $316.23 | $426.58 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $549.54 / $707.95
| Professional | | $407.38 | $549.54 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $457.09 / $707.95
| Professional | | $338.84 | $457.09 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,801.89 / $7,244.36
| Facility | | $2,290.87 | $3,801.89 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $389.05 / $446.68
| Professional | | $338.84 | $389.05 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $3,630.78 / $7,244.36
| Facility | | $588.84 | $3,630.78 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $501.19 / $1,230.27
| Professional | | $323.59 | $501.19 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $1,659.59 / $6,606.93
| Facility | | $436.52 | $1,659.59 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $512.86 / $724.44
| Professional | | $436.52 | $512.86 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $398.11 / $467.74
| Facility | | $309.03 | $398.11 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $407.38 / $467.74
| Professional | | $331.13 | $407.38 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $3,162.28 / $5,754.40
| Facility | | $1,348.96 | $3,162.28 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $398.11 / $645.65
| Professional | | $302.00 | $398.11 | $645.65 |