- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $2,754.23 / $4,897.79
| Facility | | $208.93 | $2,754.23 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $251.19 / $691.83
| Professional | | $154.88 | $251.19 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $1,949.84 / $13,489.63
| Facility | | $446.68 | $1,949.84 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $323.59 / $794.33
| Professional | | $194.98 | $323.59 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $213.80 / $489.78
| Facility | | $213.80 | $213.80 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $398.11 / $741.31
| Professional | | $257.04 | $398.11 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $331.13 / $691.83
| Professional | | $204.17 | $331.13 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $263.03 / $7,079.46
| Facility | | $158.49 | $263.03 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $363.08 / $524.81
| Professional | | $281.84 | $363.08 | $524.81 |
- 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
- $186.21 / $323.59 / $691.83
| Professional | | $186.21 | $323.59 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $562.34 / $562.34
| Facility | | $281.84 | $562.34 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $426.58 / $562.34
| Professional | | $426.58 | $426.58 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $1,949.84 / $13,489.63
| Facility | | $446.68 | $1,949.84 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $323.59 / $812.83
| Professional | | $194.98 | $323.59 | $812.83 |
- 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
- $190.55 / $331.13 / $630.96
| Professional | | $190.55 | $331.13 | $630.96 |