- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $3,388.44 / $8,317.64
| Facility | | $245.47 | $3,388.44 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $269.15 / $1,148.15
| Professional | | $162.18 | $269.15 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $181.97 / $181.97
| Professional | | $181.97 | $181.97 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $3,801.89 / $57,543.99
| Facility | | $3,801.89 | $3,801.89 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $269.15 / $269.15
| Professional | | $269.15 | $269.15 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $269.15 / $426.58
| Professional | | $177.83 | $269.15 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $426.58 / $467.74
| Professional | | $331.13 | $426.58 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $323.59 / $489.78
| Professional | | $218.78 | $323.59 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,235.94 / $5,623.41
| Facility | | $1,445.44 | $3,235.94 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $263.03 / $263.03
| Professional | | $263.03 | $263.03 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $2,570.40 / $7,943.28
| Facility | | $269.15 | $2,570.40 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $281.84 / $758.58
| Professional | | $165.96 | $281.84 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $234.42 / $234.42
| Professional | | $234.42 | $234.42 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.20 / $257.04 / $416.87
| Facility | | $112.20 | $257.04 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $263.03 / $407.38
| Professional | | $177.83 | $263.03 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $2,630.27 / $5,888.44
| Facility | | $812.83 | $2,630.27 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $245.47 / $426.58
| Professional | | $162.18 | $245.47 | $426.58 |