- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $1,905.46 / $3,715.35
| Facility | | $190.55 | $1,905.46 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $213.80 / $630.96
| Professional | | $123.03 | $213.80 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $1,071.52 / $13,489.63
| Facility | | $380.19 | $1,071.52 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $288.40 / $724.44
| Professional | | $151.36 | $288.40 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $190.55 / $436.52
| Facility | | $190.55 | $190.55 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $354.81 / $645.65
| Professional | | $190.55 | $354.81 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $309.03 / $616.60
| Professional | | $169.82 | $309.03 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $234.42 / $7,079.46
| Facility | | $138.04 | $234.42 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $338.84 / $478.63
| Professional | | $257.04 | $338.84 | $478.63 |
- 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
- $165.96 / $288.40 / $616.60
| Professional | | $165.96 | $288.40 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $457.09 / $660.69
| Facility | | $151.36 | $457.09 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $338.84 / $371.54
| Professional | | $194.98 | $338.84 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $1,071.52 / $13,489.63
| Facility | | $398.11 | $1,071.52 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $288.40 / $741.31
| Professional | | $151.36 | $288.40 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $380.19 / $501.19
| Professional | | $190.55 | $380.19 | $501.19 |
- 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
- $165.96 / $295.12 / $562.34
| Professional | | $165.96 | $295.12 | $562.34 |