- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $3,630.78 / $8,317.64
| Facility | | $190.55 | $3,630.78 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $186.21 / $389.05
| Professional | | $147.91 | $186.21 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,570.40 / $2,951.21
| Facility | | $2,137.96 | $2,570.40 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $229.09 / $316.23
| Professional | | $165.96 | $229.09 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $776.25 / $1,047.13
| Professional | | $144.54 | $776.25 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $302.00 / $1,659.59
| Facility | | $302.00 | $302.00 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $234.42 / $457.09
| Professional | | $165.96 | $234.42 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $199.53 / $234.42
| Professional | | $165.96 | $199.53 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $436.52 / $549.54
| Professional | | $436.52 | $436.52 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $208.93 / $478.63
| Facility | | $158.49 | $208.93 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $1,584.89 / $1,584.89
| Professional | | $1,584.89 | $1,584.89 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $288.40 / $2,630.27
| Facility | | $173.78 | $288.40 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $288.40 / $2,630.27
| Professional | | $173.78 | $288.40 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $1,202.26 / $2,454.71
| Facility | | $229.09 | $1,202.26 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $257.04 / $426.58
| Professional | | $147.91 | $257.04 | $426.58 |