- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $2,818.38 / $4,365.16
| Facility | | $758.58 | $2,818.38 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $812.83 / $1,621.81
| Professional | | $549.54 | $812.83 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $3,981.07 / $28,840.32
| Facility | | $1,071.52 | $3,981.07 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $933.25 / $2,344.23
| Professional | | $575.44 | $933.25 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $660.69 / $1,513.56
| Facility | | $660.69 | $660.69 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $1,148.15 / $1,659.59
| Professional | | $660.69 | $1,148.15 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $1,174.90 / $2,089.30
| Professional | | $562.34 | $1,174.90 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $1,071.52 / $7,079.46
| Facility | | $489.78 | $1,071.52 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,096.48 / $1,479.11
| Professional | | $851.14 | $1,096.48 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,981.07 / $9,772.37
| Facility | | $1,698.24 | $3,981.07 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $933.25 / $1,995.26
| Professional | | $575.44 | $933.25 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $537.03 / $870.96
| Facility | | $537.03 | $537.03 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $1,023.29 / $1,230.27
| Professional | | $389.05 | $1,023.29 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $3,981.07 / $28,840.32
| Facility | | $1,258.93 | $3,981.07 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $933.25 / $2,290.87
| Professional | | $575.44 | $933.25 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,981.07 / $9,120.11
| Facility | | $1,698.24 | $3,981.07 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $977.24 / $1,995.26
| Professional | | $575.44 | $977.24 | $1,995.26 |