- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $401.40 / $401.40 / $2,261.26
| Facility | | $401.40 | $401.40 | $2,261.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.14 / $401.40 / $2,261.26
| Professional | | $318.14 | $401.40 | $2,261.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $304.82 / $1,131.22 / $2,487.76
| Facility | | $304.82 | $1,131.22 | $2,487.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $396.13 / $424.98 / $735.33
| Professional | | $396.13 | $424.98 | $735.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.00 / $927.88 / $1,656.93
| Facility | | $97.00 | $927.88 | $1,656.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $1,039.86 / $2,422.21
| Professional | | $100.00 | $1,039.86 | $2,422.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $564.36 / $564.36 / $776.68
| Facility | | $564.36 | $564.36 | $776.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $411.98 / $411.98 / $581.29
| Professional | | $411.98 | $411.98 | $581.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $418.94 / $502.73 / $862.09
| Professional | | $418.94 | $502.73 | $862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $470.23 / $548.60 / $1,191.25
| Professional | | $470.23 | $548.60 | $1,191.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,605.08 / $3,722.67 / $3,722.67
| Facility | | $1,605.08 | $3,722.67 | $3,722.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,773.79 / $3,773.79 / $5,012.47
| Professional | | $3,773.79 | $3,773.79 | $5,012.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,502.07 / $1,502.07 / $1,502.07
| Professional | | $1,502.07 | $1,502.07 | $1,502.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $215.25 / $710.05 / $794.34
| Facility | | $215.25 | $710.05 | $794.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $411.98 / $564.36 / $690.07
| Professional | | $411.98 | $564.36 | $690.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.26 / $1,479.26 / $1,479.26
| Professional | | $1,479.26 | $1,479.26 | $1,479.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $418.94 / $626.98 / $628.41
| Professional | | $418.94 | $626.98 | $628.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.85 / $387.51 / $744.59
| Professional | | $313.85 | $387.51 | $744.59 |