- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $2,089.30 / $3,801.89
| Facility | | $407.38 | $2,089.30 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $177.83 / $512.86
| Professional | | $83.18 | $177.83 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $1,071.52 / $13,489.63
| Facility | | $263.03 | $1,071.52 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $186.21 / $457.09
| Professional | | $102.33 | $186.21 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $128.82 / $288.40
| Facility | | $128.82 | $128.82 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $223.87 / $407.38
| Professional | | $128.82 | $223.87 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $194.98 / $407.38
| Professional | | $112.20 | $194.98 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.72 / $208.93 / $7,079.46
| Facility | | $97.72 | $208.93 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $213.80 / $309.03
| Professional | | $165.96 | $213.80 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,041.74 / $3,467.37
| Facility | | $630.96 | $2,041.74 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $190.55 / $398.11
| Professional | | $114.82 | $190.55 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $501.19 / $912.01
| Facility | | $138.04 | $501.19 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $162.18 / $281.84
| Professional | | $100.00 | $162.18 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $1,071.52 / $13,489.63
| Facility | | $263.03 | $1,071.52 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $186.21 / $478.63
| Professional | | $109.65 | $186.21 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,819.70 / $2,818.38
| Facility | | $575.44 | $1,819.70 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $194.98 / $371.54
| Professional | | $109.65 | $194.98 | $371.54 |