- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,454.71 / $6,918.31
| Facility | | $630.96 | $2,454.71 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $602.56 / $1,148.15
| Professional | | $323.59 | $602.56 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,754.23 / $5,370.32
| Facility | | $1,584.89 | $2,754.23 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $724.44 / $1,122.02
| Professional | | $398.11 | $724.44 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $2,290.87 / $2,290.87
| Facility | | $407.38 | $2,290.87 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $691.83 / $1,174.90
| Professional | | $407.38 | $691.83 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $19,498.45 / $19,498.45
| Facility | | $5,248.07 | $19,498.45 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,309.57 / $7,762.47 / $7,762.47
| Professional | | $6,309.57 | $7,762.47 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $741.31 / $2,187.76
| Facility | | $371.54 | $741.31 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $645.65 / $1,905.46
| Professional | | $331.13 | $645.65 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $758.58
| Professional | | $32.36 | $33.11 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $1,513.56 / $3,981.07
| Professional | | $446.68 | $1,513.56 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $660.69 / $1,318.26
| Facility | | $354.81 | $660.69 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $691.83 / $1,202.26
| Professional | | $389.05 | $691.83 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $4,073.80 / $8,912.51
| Facility | | $1,380.38 | $4,073.80 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $524.81 / $912.01
| Professional | | $309.03 | $524.81 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,122.02 / $1,122.02
| Professional | | $1,047.13 | $1,122.02 | $1,122.02 |