- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $2,454.71 / $6,760.83
| Facility | | $398.11 | $2,454.71 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $309.03 / $977.24
| Professional | | $194.98 | $309.03 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $208.93 / $295.12
| Professional | | $131.83 | $208.93 | $295.12 |
- 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
- $288.40 / $501.19 / $588.84
| Professional | | $288.40 | $501.19 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $288.40 / $436.52
| Professional | | $194.98 | $288.40 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $363.08 / $389.05
| Professional | | $363.08 | $363.08 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $331.13 / $524.81
| Professional | | $223.87 | $331.13 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $3,467.37 / $6,760.83
| Facility | | $1,778.28 | $3,467.37 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $229.09 / $257.04
| Professional | | $213.80 | $229.09 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $2,398.83 / $6,309.57
| Facility | | $346.74 | $2,398.83 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $316.23 / $724.44
| Professional | | $204.17 | $316.23 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $467.74 / $676.08
| Professional | | $467.74 | $467.74 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $218.78 / $398.11
| Facility | | $186.21 | $218.78 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $218.78 / $363.08
| Professional | | $186.21 | $218.78 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $2,630.27 / $5,623.41
| Facility | | $912.01 | $2,630.27 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $269.15 / $436.52
| Professional | | $190.55 | $269.15 | $436.52 |