- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $758.58 / $17,782.79
| Facility | | $758.58 | $758.58 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $691.83 / $1,023.29
| Professional | | $549.54 | $691.83 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $8,128.31 / $13,489.63
| Facility | | $5,011.87 | $8,128.31 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $1,318.26 / $3,235.94
| Professional | | $645.65 | $1,318.26 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $3,801.89 / $6,165.95
| Facility | | $3,311.31 | $3,801.89 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $2,884.03 / $5,370.32
| Professional | | $741.31 | $2,884.03 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $933.25 / $8,709.64
| Facility | | $602.56 | $933.25 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,630.78 / $3,630.78 / $3,630.78
| Professional | | $3,630.78 | $3,630.78 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $1,071.52 / $5,888.44
| Facility | | $660.69 | $1,071.52 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $1,737.80 / $5,248.07
| Professional | | $645.65 | $1,737.80 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $50.12 / $85.11
| Professional | | $32.36 | $50.12 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,548.82 / $2,290.87
| Professional | | $851.14 | $1,548.82 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $1,737.80 / $6,309.57
| Facility | | $1,737.80 | $1,737.80 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $3,981.07 / $5,011.87
| Professional | | $691.83 | $3,981.07 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,570.88 / $4,570.88 / $4,570.88
| Professional | | $4,570.88 | $4,570.88 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,570.88 / $6,606.93 / $7,079.46
| Professional | | $4,570.88 | $6,606.93 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $6,165.95 / $19,498.45
| Facility | | $2,290.87 | $6,165.95 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $1,412.54 / $4,365.16
| Professional | | $602.56 | $1,412.54 | $4,365.16 |