- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $2,089.30 / $3,715.35
| Facility | | $134.90 | $2,089.30 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $169.82 / $457.09
| Professional | | $102.33 | $169.82 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $758.58 / $3,890.45
| Facility | | $56.23 | $758.58 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $208.93 / $524.81
| Professional | | $120.23 | $208.93 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $141.25 / $323.59
| Facility | | $141.25 | $141.25 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $257.04 / $467.74
| Professional | | $141.25 | $257.04 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $50.12 / $50.12
| Facility | | $50.12 | $50.12 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $223.87 / $446.68
| Professional | | $131.83 | $223.87 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.33 / $218.78 / $7,079.46
| Facility | | $102.33 | $218.78 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $245.47 / $346.74
| Professional | | $186.21 | $245.47 | $346.74 |
- 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
- $120.23 / $213.80 / $457.09
| Professional | | $120.23 | $213.80 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $257.04 / $302.00
| Professional | | $181.97 | $257.04 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $758.58 / $3,890.45
| Facility | | $56.23 | $758.58 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $208.93 / $537.03
| Professional | | $120.23 | $208.93 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,819.70 / $2,818.38
| Facility | | $501.19 | $1,819.70 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $213.80 / $416.87
| Professional | | $120.23 | $213.80 | $416.87 |