- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $1,995.26 / $1,995.26
| Facility | | $870.96 | $1,995.26 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $588.84 / $870.96
| Professional | | $501.19 | $588.84 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,949.84 / $1,995.26
| Facility | | $1,548.82 | $1,949.84 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $229.09 / $2,511.89
| Professional | | $194.98 | $229.09 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,290.87 / $3,715.35
| Facility | | $1,995.26 | $2,290.87 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,819.70 / $2,238.72
| Professional | | $831.76 | $1,819.70 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $3,019.95 / $4,570.88
| Facility | | $794.33 | $3,019.95 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,265.80 / $4,265.80 / $4,786.30
| Professional | | $4,265.80 | $4,265.80 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $870.96 / $2,511.89
| Facility | | $645.65 | $870.96 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $436.52 / $3,630.78
| Professional | | $323.59 | $436.52 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $64.57 / $363.08
| Professional | | $50.12 | $64.57 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,698.24 / $2,398.83
| Professional | | $1,174.90 | $1,698.24 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,388.44 / $3,388.44
| Facility | | $1,445.44 | $3,388.44 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $3,630.78 / $3,630.78
| Professional | | $1,047.13 | $3,630.78 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,548.82 / $1,548.82
| Professional | | $1,548.82 | $1,548.82 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $3,890.45 / $5,495.41
| Professional | | $2,089.30 | $3,890.45 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $575.44 / $870.96
| Facility | | $575.44 | $575.44 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $436.52 / $1,174.90
| Professional | | $302.00 | $436.52 | $1,174.90 |