- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $2,951.21 / $7,413.10
| Facility | | $707.95 | $2,951.21 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $331.13 / $524.81
| Professional | | $234.42 | $331.13 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $3,890.45 / $7,079.46
| Facility | | $2,089.30 | $3,890.45 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $234.42 / $371.54
| Facility | | $234.42 | $234.42 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $1,862.09 / $2,187.76
| Facility | | $407.38 | $1,862.09 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $363.08 / $616.60
| Professional | | $245.47 | $363.08 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $28,840.32 / $28,840.32
| Facility | | $7,943.28 | $28,840.32 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $2,951.21 / $2,951.21
| Professional | | $2,511.89 | $2,951.21 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $363.08 / $831.76
| Facility | | $229.09 | $363.08 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $338.84 / $575.44
| Professional | | $234.42 | $338.84 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $295.12
| Professional | | $32.36 | $33.11 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $616.60 / $933.25
| Professional | | $281.84 | $616.60 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $346.74 / $616.60
| Facility | | $223.87 | $346.74 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $371.54 / $645.65
| Professional | | $245.47 | $371.54 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $2,511.89 / $4,786.30
| Facility | | $676.08 | $2,511.89 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $288.40 / $446.68
| Professional | | $204.17 | $288.40 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $363.08 / $416.87
| Professional | | $177.83 | $363.08 | $416.87 |