- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $2,187.76 / $3,801.89
| Facility | | $162.18 | $2,187.76 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $177.83 / $371.54
| Professional | | $120.23 | $177.83 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $3,162.28 / $19,498.45
| Facility | | $323.59 | $3,162.28 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $229.09 / $549.54
| Professional | | $138.04 | $229.09 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $158.49 / $354.81
| Facility | | $158.49 | $158.49 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $269.15 / $478.63
| Professional | | $158.49 | $269.15 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $257.04 / $436.52
| Professional | | $144.54 | $257.04 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $380.19 / $7,079.46
| Facility | | $128.82 | $380.19 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $251.19 / $346.74
| Professional | | $199.53 | $251.19 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,630.78 / $8,511.38
| Facility | | $1,698.24 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $257.04 / $457.09
| Professional | | $147.91 | $257.04 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $3,162.28 / $19,498.45
| Facility | | $323.59 | $3,162.28 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $229.09 / $549.54
| Professional | | $138.04 | $229.09 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,630.78 / $8,511.38
| Facility | | $1,584.89 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $239.88 / $467.74
| Professional | | $147.91 | $239.88 | $467.74 |