- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $2,570.40 / $8,317.64
| Facility | | $269.15 | $2,570.40 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $213.80 / $457.09
| Professional | | $85.11 | $213.80 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $102.33 / $234.42
| Professional | | $102.33 | $102.33 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,258.93 / $57,543.99
| Facility | | $1,174.90 | $1,258.93 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $380.19 / $501.19
| Professional | | $218.78 | $380.19 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $245.47 / $478.63
| Professional | | $109.65 | $245.47 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $389.05 / $426.58
| Professional | | $302.00 | $389.05 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $302.00 / $478.63
| Professional | | $114.82 | $302.00 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,454.71 / $3,715.35
| Facility | | $1,348.96 | $2,454.71 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $107.15 / $107.15
| Professional | | $107.15 | $107.15 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $2,398.83 / $8,317.64
| Facility | | $416.87 | $2,398.83 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $234.42 / $691.83
| Professional | | $89.13 | $234.42 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $323.59 / $549.54
| Facility | | $323.59 | $323.59 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $501.19 / $2,454.71
| Professional | | $309.03 | $501.19 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.72 / $251.19 / $354.81
| Facility | | $97.72 | $251.19 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $251.19 / $354.81
| Professional | | $93.33 | $251.19 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,584.89 / $3,890.45
| Facility | | $501.19 | $1,584.89 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $218.78 / $426.58
| Professional | | $95.50 | $218.78 | $426.58 |