- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $2,630.27 / $5,128.61
| Facility | | $234.42 | $2,630.27 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $389.05 / $1,230.27
| Professional | | $213.80 | $389.05 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $3,548.13 / $28,840.32
| Facility | | $602.56 | $3,548.13 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $380.19 / $933.25
| Professional | | $213.80 | $380.19 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $295.12 / $676.08
| Facility | | $295.12 | $295.12 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $501.19 / $831.76
| Professional | | $295.12 | $501.19 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $416.87 / $891.25
| Professional | | $257.04 | $416.87 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $501.19 / $7,079.46
| Facility | | $234.42 | $501.19 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $446.68 / $645.65
| Professional | | $346.74 | $446.68 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,630.78 / $8,511.38
| Facility | | $1,698.24 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $446.68 / $870.96
| Professional | | $275.42 | $446.68 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $3,311.31 / $5,495.41
| Facility | | $1,737.80 | $3,311.31 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $457.09 / $512.86
| Professional | | $295.12 | $457.09 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $3,548.13 / $28,840.32
| Facility | | $602.56 | $3,548.13 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $389.05 / $954.99
| Professional | | $213.80 | $389.05 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,630.78 / $8,511.38
| Facility | | $1,584.89 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $407.38 / $831.76
| Professional | | $234.42 | $407.38 | $831.76 |