- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $2,089.30 / $3,715.35
| Facility | | $263.03 | $2,089.30 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $323.59 / $776.25
| Professional | | $239.88 | $323.59 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $676.08 / $3,467.37
| Facility | | $56.23 | $676.08 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $1,148.15 / $1,148.15 / $1,148.15
| Facility | 54 | $1,148.15 | $1,148.15 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $398.11 / $1,023.29
| Professional | | $234.42 | $398.11 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $331.13 / $758.58
| Facility | | $331.13 | $331.13 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $562.34 / $812.83
| Professional | | $331.13 | $562.34 | $812.83 |
- 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
- $281.84 / $436.52 / $794.33
| Professional | | $281.84 | $436.52 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $446.68 / $7,079.46
| Facility | | $177.83 | $446.68 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $478.63 / $588.84
| Professional | | $389.05 | $478.63 | $588.84 |
- 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
- $331.13 / $524.81 / $851.14
| Professional | | $331.13 | $524.81 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $562.34 / $575.44
| Facility | | $562.34 | $562.34 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $676.08 / $3,467.37
| Facility | | $56.23 | $676.08 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $1,148.15 / $1,148.15 / $1,148.15
| Facility | 54 | $1,148.15 | $1,148.15 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $398.11 / $1,023.29
| Professional | | $234.42 | $398.11 | $1,023.29 |
- 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
- $257.04 / $407.38 / $851.14
| Professional | | $257.04 | $407.38 | $851.14 |