- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $2,691.53 / $5,128.61
| Facility | | $457.09 | $2,691.53 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $537.03 / $1,778.28
| Professional | | $316.23 | $537.03 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $3,162.28 / $28,840.32
| Facility | | $758.58 | $3,162.28 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $630.96 / $1,698.24
| Professional | | $354.81 | $630.96 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $380.19 / $870.96
| Facility | | $380.19 | $380.19 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $676.08 / $1,412.54
| Professional | | $380.19 | $676.08 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $676.08 / $1,288.25
| Professional | | $346.74 | $676.08 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $676.08 / $7,079.46
| Facility | | $309.03 | $676.08 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $794.33 / $1,071.52
| Professional | | $645.65 | $794.33 | $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
- $371.54 / $676.08 / $1,445.44
| Professional | | $371.54 | $676.08 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $2,290.87 / $3,311.31
| Facility | | $741.31 | $2,290.87 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $2,187.76 / $2,187.76
| Professional | | $1,096.48 | $2,187.76 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $3,162.28 / $28,840.32
| Facility | | $758.58 | $3,162.28 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $630.96 / $1,698.24
| Professional | | $354.81 | $630.96 | $1,698.24 |
- 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
- $371.54 / $660.69 / $1,412.54
| Professional | | $371.54 | $660.69 | $1,412.54 |