- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $2,041.74 / $8,317.64
| Facility | | $181.97 | $2,041.74 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $239.88 / $446.68
| Professional | | $154.88 | $239.88 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,981.07 / $4,466.84
| Facility | | $3,090.30 | $3,981.07 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $234.42 / $398.11
| Professional | | $158.49 | $234.42 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $234.42 / $3,548.13
| Professional | | $162.18 | $234.42 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $416.87 / $416.87
| Facility | | $416.87 | $416.87 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $269.15 / $467.74
| Professional | | $165.96 | $269.15 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $323.59 / $389.05
| Professional | | $257.04 | $323.59 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $338.84 / $602.56
| Professional | | $269.15 | $338.84 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $269.15 / $446.68
| Facility | | $158.49 | $269.15 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $151.36 / $151.36
| Professional | | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $213.80 / $2,290.87
| Facility | | $151.36 | $213.80 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $316.23 / $2,290.87
| Professional | | $234.42 | $316.23 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $2,137.96 / $3,981.07
| Facility | | $1,071.52 | $2,137.96 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $234.42 / $426.58
| Professional | | $134.90 | $234.42 | $426.58 |