- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $2,630.27 / $8,317.64
| Facility | | $83.18 | $2,630.27 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $109.65 / $245.47
| Professional | | $75.86 | $109.65 | $245.47 |
- 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
- $75.86 / $114.82 / $194.98
| Professional | | $75.86 | $114.82 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $109.65 / $1,047.13
| Professional | | $75.86 | $109.65 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $645.65 / $645.65
| Facility | | $645.65 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $120.23 / $208.93
| Professional | | $81.28 | $120.23 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $154.88 / $186.21
| Professional | | $120.23 | $154.88 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $263.03 / $263.03
| Professional | | $263.03 | $263.03 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.43 / $120.23 / $194.98
| Facility | | $79.43 | $120.23 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $85.11 / $85.11
| Professional | | $85.11 | $85.11 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $72.44 / $97.72 / $1,288.25
| Facility | | $72.44 | $97.72 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $134.90 / $1,288.25
| Professional | | $95.50 | $134.90 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $1,148.15 / $2,398.83
| Facility | | $218.78 | $1,148.15 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $109.65 / $190.55
| Professional | | $67.61 | $109.65 | $190.55 |