- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $2,398.83 / $7,762.47
| Facility | | $309.03 | $2,398.83 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $194.98 / $588.84
| Professional | | $147.91 | $194.98 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $269.15 / $269.15
| Professional | | $269.15 | $269.15 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,258.93 / $57,543.99
| Facility | | $1,174.90 | $1,258.93 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $269.15 / $389.05
| Professional | | $177.83 | $269.15 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $223.87 / $363.08
| Professional | | $169.82 | $223.87 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $295.12 / $323.59
| Professional | | $229.09 | $295.12 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $239.88 / $363.08
| Professional | | $173.78 | $239.88 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,778.28 / $3,467.37
| Facility | | $776.25 | $1,778.28 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $2,089.30 / $7,244.36
| Facility | | $537.03 | $2,089.30 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $234.42 / $524.81
| Professional | | $158.49 | $234.42 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $208.93 / $371.54
| Facility | | $208.93 | $208.93 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $338.84 / $407.38
| Professional | | $199.53 | $338.84 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $177.83 / $489.78
| Facility | | $54.95 | $177.83 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $181.97 / $489.78
| Professional | | $81.28 | $181.97 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,584.89 / $3,890.45
| Facility | | $501.19 | $1,584.89 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $194.98 / $331.13
| Professional | | $144.54 | $194.98 | $331.13 |