- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $2,951.21 / $7,943.28
| Facility | | $776.25 | $2,951.21 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $724.44 / $1,148.15
| Professional | | $501.19 | $724.44 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $707.95 / $2,818.38
| Facility | | $426.58 | $707.95 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $645.65 / $1,023.29
| Professional | | $457.09 | $645.65 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $407.38 / $707.95
| Facility | | $407.38 | $407.38 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $549.54 / $549.54
| Facility | | $549.54 | $549.54 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $741.31 / $1,174.90
| Professional | | $501.19 | $741.31 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $56.23 / $3,388.44
| Facility | | $54.95 | $56.23 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,011.87 / $5,754.40 / $5,754.40
| Professional | | $5,011.87 | $5,754.40 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $794.33 / $3,801.89
| Facility | | $467.74 | $794.33 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $724.44 / $1,174.90
| Professional | | $501.19 | $724.44 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $380.19 / $676.08
| Professional | | $32.36 | $380.19 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $616.60 / $616.60
| Professional | | $616.60 | $616.60 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $707.95 / $1,122.02
| Facility | | $436.52 | $707.95 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $741.31 / $1,174.90
| Professional | | $512.86 | $741.31 | $1,174.90 |
- 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
- $416.87 / $616.60 / $912.01
| Professional | | $416.87 | $616.60 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $707.95 / $707.95
| Professional | | $676.08 | $707.95 | $707.95 |