- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $2,187.76 / $3,715.35
| Facility | | $588.84 | $2,187.76 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $309.03 / $1,258.93
| Professional | | $69.18 | $309.03 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,479.11 / $4,897.79
| Facility | | $56.23 | $1,479.11 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $549.54 / $3,981.07
| Professional | | $74.13 | $549.54 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $77.62 / $77.62 / $181.97
| Facility | | $77.62 | $77.62 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $389.05 / $1,513.56
| Professional | | $93.33 | $389.05 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $741.31 / $1,905.46
| Facility | | $446.68 | $741.31 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $239.88 / $1,380.38
| Professional | | $81.28 | $239.88 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.66 / $128.82 / $8,511.38
| Facility | | $61.66 | $128.82 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $870.96 / $1,318.26
| Professional | | $602.56 | $870.96 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $3,162.28 / $8,511.38
| Facility | | $616.60 | $3,162.28 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $562.34 / $1,412.54
| Professional | | $74.13 | $562.34 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $4,073.80 / $4,073.80
| Facility | | $4,073.80 | $4,073.80 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $112.20 / $112.20
| Professional | | $112.20 | $112.20 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,479.11 / $4,897.79
| Facility | | $56.23 | $1,479.11 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $549.54 / $3,981.07
| Professional | | $74.13 | $549.54 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $3,467.37 / $8,511.38
| Facility | | $812.83 | $3,467.37 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $257.04 / $1,348.96
| Professional | | $75.86 | $257.04 | $1,348.96 |