- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $1,148.15 / $2,187.76
| Facility | | $537.03 | $1,148.15 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $575.44 / $1,412.54
| Professional | | $512.86 | $575.44 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $4,570.88 / $7,079.46
| Facility | | $2,344.23 | $4,570.88 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $1,122.02 / $2,630.27
| Professional | | $549.54 | $1,122.02 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,819.70 / $2,884.03
| Facility | | $1,548.82 | $1,819.70 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $1,819.70 / $2,754.23
| Professional | | $660.69 | $1,819.70 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $831.76 / $3,162.28
| Facility | | $537.03 | $831.76 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,380.38 / $1,778.28
| Professional | | $1,023.29 | $1,380.38 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $851.14 / $1,778.28
| Facility | | $537.03 | $851.14 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $1,096.48 / $4,365.16
| Professional | | $575.44 | $1,096.48 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $691.83
| Professional | | $32.36 | $33.11 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,479.11 / $2,089.30
| Professional | | $954.99 | $1,479.11 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $3,235.94 / $4,786.30
| Facility | | $1,737.80 | $3,235.94 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $2,754.23 / $4,265.80
| Professional | | $954.99 | $2,754.23 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $1,778.28 / $1,862.09
| Professional | | $1,778.28 | $1,778.28 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,548.13 / $3,715.35
| Professional | | $1,698.24 | $3,548.13 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,584.89 / $2,187.76
| Facility | | $1,023.29 | $1,584.89 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $812.83 / $2,290.87
| Professional | | $549.54 | $812.83 | $2,290.87 |