- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.95 / $269.15 / $3,235.94
| Facility | | $0.95 | $269.15 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $218.78 / $416.87
| Professional | | $125.89 | $218.78 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $4,570.88 / $7,079.46
| Facility | | $2,630.27 | $4,570.88 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $346.74 / $912.01
| Professional | | $169.82 | $346.74 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $724.44 / $1,148.15
| Facility | | $616.60 | $724.44 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $354.81 / $870.96
| Professional | | $151.36 | $354.81 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.89 / $213.80 / $2,238.72
| Facility | | $125.89 | $213.80 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $407.38 / $630.96
| Professional | | $239.88 | $407.38 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.89 / $218.78 / $3,235.94
| Facility | | $125.89 | $218.78 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $501.19 / $1,698.24
| Professional | | $213.80 | $501.19 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $177.83
| Professional | | $32.36 | $33.11 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $407.38 / $741.31
| Professional | | $213.80 | $407.38 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,951.21 / $2,951.21
| Facility | | $630.96 | $2,951.21 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $478.63 / $1,621.81
| Professional | | $144.54 | $478.63 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $707.95 / $1,174.90
| Professional | | $407.38 | $707.95 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,801.89 / $6,606.93
| Facility | | $2,884.03 | $3,801.89 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $239.88 / $630.96
| Professional | | $134.90 | $239.88 | $630.96 |