- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $2,691.53 / $3,715.35
| Facility | | $407.38 | $2,691.53 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $794.33 / $2,951.21
| Professional | | $114.82 | $794.33 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $851.14 / $3,715.35
| Facility | | $56.23 | $851.14 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $1,023.29 / $3,630.78
| Professional | | $125.89 | $1,023.29 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $134.90 / $316.23
| Facility | | $134.90 | $134.90 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $794.33 / $3,388.44
| Professional | | $199.53 | $794.33 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $676.08 / $741.31
| Facility | | $50.12 | $676.08 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $457.09 / $2,691.53
| Professional | | $138.04 | $457.09 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $218.78 / $7,079.46
| Facility | | $104.71 | $218.78 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,905.46 / $2,630.27
| Professional | | $1,318.26 | $1,905.46 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $1,949.84 / $7,079.46
| Facility | | $346.74 | $1,949.84 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $1,148.15 / $2,951.21
| Professional | | $125.89 | $1,148.15 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $1,862.09 / $2,691.53
| Facility | | $1,698.24 | $1,862.09 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $851.14 / $3,715.35
| Facility | | $56.23 | $851.14 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $1,023.29 / $3,630.78
| Professional | | $125.89 | $1,023.29 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $2,238.72 / $6,165.95
| Facility | | $537.03 | $2,238.72 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $630.96 / $2,884.03
| Professional | | $125.89 | $630.96 | $2,884.03 |