- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $702.40 / $2,344.37 / $5,510.07
| Facility | | $702.40 | $2,344.37 | $5,510.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $550.08 / $719.33 / $5,441.52
| Professional | | $550.08 | $719.33 | $5,441.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $392.54 / $1,520.07 / $4,172.10
| Facility | | $392.54 | $1,520.07 | $4,172.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.51 / $792.98 / $1,941.76
| Professional | | $338.51 | $792.98 | $1,941.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $98.20 / $1,277.86 / $2,327.23
| Facility | | $98.20 | $1,277.86 | $2,327.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $385.06 / $550.08 / $1,382.85
| Professional | | $385.06 | $550.08 | $1,382.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.25 / $1,419.21 / $2,832.91
| Facility | | $575.25 | $1,419.21 | $2,832.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $447.98 / $704.02 / $2,569.33
| Professional | | $447.98 | $704.02 | $2,569.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $677.01 / $846.27 / $1,142.46
| Professional | | $677.01 | $846.27 | $1,142.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $761.64 / $973.21 / $1,650.23
| Professional | | $761.64 | $973.21 | $1,650.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,472.51 / $4,019.78 / $4,019.78
| Facility | | $1,472.51 | $4,019.78 | $4,019.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,231.35 / $4,231.35 / $6,347.03
| Professional | | $4,231.35 | $4,231.35 | $6,347.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $677.02 / $1,015.52 / $2,427.50
| Facility | | $677.02 | $1,015.52 | $2,427.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $454.62 / $973.21 / $2,288.15
| Professional | | $454.62 | $973.21 | $2,288.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,970.40 / $2,970.40 / $2,970.40
| Professional | | $2,970.40 | $2,970.40 | $2,970.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $677.02 / $761.64 / $1,150.92
| Professional | | $677.02 | $761.64 | $1,150.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.43 / $355.43 / $1,833.95
| Professional | | $355.43 | $355.43 | $1,833.95 |