- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $2,398.83 / $8,317.64
| Facility | | $380.19 | $2,398.83 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $288.40 / $741.31
| Professional | | $79.43 | $288.40 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $162.18 / $162.18
| Professional | | $89.13 | $162.18 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $3,801.89 / $57,543.99
| Facility | | $3,801.89 | $3,801.89 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $446.68 / $630.96
| Professional | | $316.23 | $446.68 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $346.74 / $660.69
| Professional | | $186.21 | $346.74 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $630.96 / $691.83
| Professional | | $489.78 | $630.96 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $489.78 / $724.44
| Professional | | $213.80 | $489.78 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $10,964.78 / $19,054.61
| Facility | | $1,819.70 | $10,964.78 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $2,089.30 / $8,317.64
| Facility | | $407.38 | $2,089.30 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $380.19 / $891.25
| Professional | | $169.82 | $380.19 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $398.11 / $794.33
| Facility | | $398.11 | $398.11 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $691.83 / $851.14
| Professional | | $331.13 | $691.83 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43.65 / $380.19 / $512.86
| Facility | | $43.65 | $380.19 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $354.81 / $407.38
| Professional | | $169.82 | $354.81 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $2,818.38 / $11,481.54
| Facility | | $912.01 | $2,818.38 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $323.59 / $575.44
| Professional | | $165.96 | $323.59 | $575.44 |