- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $3,630.78 / $12,022.64
| Facility | | $891.25 | $3,630.78 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $870.96 / $1,380.38
| Professional | | $741.31 | $870.96 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $4,365.16 / $8,709.64
| Facility | | $2,454.71 | $4,365.16 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $977.24 / $1,318.26
| Professional | | $776.25 | $977.24 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.43 / $794.33 / $794.33
| Facility | | $79.43 | $794.33 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,096.48 / $1,659.59
| Professional | | $812.83 | $1,096.48 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $45,708.82 / $45,708.82
| Facility | | $8,912.51 | $45,708.82 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,025.60 / $7,244.36 / $7,244.36
| Professional | | $6,025.60 | $7,244.36 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,148.15 / $3,890.45
| Facility | | $812.83 | $1,148.15 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,071.52 / $1,479.11
| Professional | | $741.31 | $1,071.52 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $109.65 / $724.44
| Professional | | $32.36 | $109.65 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,047.13 / $1,047.13
| Professional | | $1,047.13 | $1,047.13 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,071.52 / $1,737.80
| Facility | | $812.83 | $1,071.52 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,071.52 / $1,737.80
| Professional | | $776.25 | $1,071.52 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $5,248.07 / $10,964.78
| Facility | | $1,698.24 | $5,248.07 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $851.14 / $1,318.26
| Professional | | $645.65 | $851.14 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $851.14 / $851.14
| Professional | | $794.33 | $851.14 | $851.14 |