- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $2,818.38 / $5,128.61
| Facility | | $478.63 | $2,818.38 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $512.86 / $1,096.48
| Professional | | $398.11 | $512.86 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $3,981.07 / $28,840.32
| Facility | | $977.24 | $3,981.07 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $588.84 / $1,513.56
| Professional | | $354.81 | $588.84 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $489.78 / $1,122.02
| Facility | | $489.78 | $489.78 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $1,348.96 / $1,348.96
| Professional | | $602.56 | $1,348.96 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,348.96 / $1,348.96
| Facility | | $1,348.96 | $1,348.96 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $812.83 / $1,479.11
| Professional | | $416.87 | $812.83 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $812.83 / $7,079.46
| Facility | | $371.54 | $812.83 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $691.83 / $933.25
| Professional | | $537.03 | $691.83 | $933.25 |
- 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
- $436.52 / $660.69 / $1,288.25
| Professional | | $436.52 | $660.69 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $3,981.07 / $28,840.32
| Facility | | $977.24 | $3,981.07 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $588.84 / $1,513.56
| Professional | | $354.81 | $588.84 | $1,513.56 |
- 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
- $436.52 / $602.56 / $1,288.25
| Professional | | $436.52 | $602.56 | $1,288.25 |