- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $2,691.53 / $4,897.79
| Facility | | $223.87 | $2,691.53 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $263.03 / $645.65
| Professional | | $169.82 | $263.03 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $4,570.88 / $11,220.18
| Facility | | $56.23 | $4,570.88 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $363.08 / $831.76
| Professional | | $208.93 | $363.08 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $218.78 / $501.19
| Facility | | $218.78 | $218.78 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $363.08 / $794.33
| Professional | | $218.78 | $363.08 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $380.19 / $7,079.46
| Facility | | $173.78 | $380.19 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $436.52 / $630.96
| Professional | | $338.84 | $436.52 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,248.07 / $11,220.18
| Facility | | $2,137.96 | $5,248.07 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $389.05 / $831.76
| Professional | | $208.93 | $389.05 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,174.90 / $1,174.90
| Facility | | $1,174.90 | $1,174.90 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $4,570.88 / $11,220.18
| Facility | | $56.23 | $4,570.88 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $363.08 / $851.14
| Professional | | $208.93 | $363.08 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $5,248.07 / $9,332.54
| Facility | | $2,041.74 | $5,248.07 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $389.05 / $741.31
| Professional | | $218.78 | $389.05 | $741.31 |