- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $1,819.70 / $3,715.35
| Facility | | $199.53 | $1,819.70 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $199.53 / $562.34
| Professional | | $112.20 | $199.53 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $1,949.84 / $13,489.63
| Facility | | $363.08 | $1,949.84 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $239.88 / $575.44
| Professional | | $151.36 | $239.88 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $177.83 / $407.38
| Facility | | $177.83 | $177.83 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $316.23 / $501.19
| Professional | | $199.53 | $316.23 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $251.19 / $524.81
| Professional | | $154.88 | $251.19 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $229.09 / $7,079.46
| Facility | | $134.90 | $229.09 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $263.03 / $380.19
| Professional | | $204.17 | $263.03 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $2,511.89 / $7,079.46
| Facility | | $1,096.48 | $2,511.89 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $257.04 / $501.19
| Professional | | $158.49 | $257.04 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $1,071.52 / $4,168.69
| Facility | | $144.54 | $1,071.52 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $177.83 / $316.23
| Professional | | $154.88 | $177.83 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $1,949.84 / $13,489.63
| Facility | | $363.08 | $1,949.84 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $245.47 / $588.84
| Professional | | $151.36 | $245.47 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $2,344.23 / $6,165.95
| Facility | | $954.99 | $2,344.23 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $245.47 / $489.78
| Professional | | $151.36 | $245.47 | $489.78 |