- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $676.08 / $1,071.52
| Facility | | $302.00 | $676.08 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $199.53 / $281.84
| Professional | | $162.18 | $199.53 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $8,511.38 / $77,624.71
| Facility | | $5,011.87 | $8,511.38 | $77,624.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $190.55 / $190.55
| Professional | | $190.55 | $190.55 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.96 / $380.19 / $851.14
| Facility | | $165.96 | $380.19 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $354.81 / $1,621.81
| Professional | | $281.84 | $354.81 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $144.54 / $354.81
| Professional | | $114.82 | $144.54 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $245.47 / $245.47
| Facility | | $245.47 | $245.47 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $229.09 / $426.58
| Professional | | $186.21 | $229.09 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $676.08 / $1,071.52
| Facility | | $275.42 | $676.08 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $208.93 / $870.96
| Professional | | $162.18 | $208.93 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.20 / $245.47 / $269.15
| Facility | | $91.20 | $245.47 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $245.47 / $269.15
| Professional | | $91.20 | $245.47 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $245.47 / $295.12
| Facility | | $134.90 | $245.47 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $147.91 / $371.54
| Professional | | $104.71 | $147.91 | $371.54 |