- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $1,905.46 / $6,025.60
| Facility | | $173.78 | $1,905.46 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $234.42 / $691.83
| Professional | | $131.83 | $234.42 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $4,570.88 / $7,079.46
| Facility | | $2,630.27 | $4,570.88 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $389.05 / $851.14
| Professional | | $194.98 | $389.05 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $645.65 / $1,023.29
| Facility | | $549.54 | $645.65 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $346.74 / $616.60
| Professional | | $173.78 | $346.74 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $426.58 / $3,311.31
| Facility | | $151.36 | $426.58 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $426.58 / $616.60
| Professional | | $295.12 | $426.58 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $426.58 / $5,248.07
| Facility | | $158.49 | $426.58 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $346.74 / $1,174.90
| Professional | | $190.55 | $346.74 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $457.09
| Professional | | $32.36 | $33.11 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $457.09 / $691.83
| Professional | | $281.84 | $457.09 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,041.74 / $2,041.74
| Facility | | $831.76 | $2,041.74 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $281.84 / $1,479.11
| Professional | | $158.49 | $281.84 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $676.08 / $891.25
| Professional | | $309.03 | $676.08 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,801.89 / $6,456.54
| Facility | | $2,884.03 | $3,801.89 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $275.42 / $691.83
| Professional | | $162.18 | $275.42 | $691.83 |