- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $2,238.72 / $3,801.89
| Facility | | $204.17 | $2,238.72 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $204.17 / $426.58
| Professional | | $114.82 | $204.17 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $3,630.78 / $19,498.45
| Facility | | $316.23 | $3,630.78 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $251.19 / $1,548.82
| Professional | | $125.89 | $251.19 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.91 / $147.91 / $338.84
| Facility | | $147.91 | $147.91 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $457.09 / $1,659.59
| Professional | | $257.04 | $457.09 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $478.63 / $2,691.53
| Facility | | $446.68 | $478.63 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $245.47 / $524.81
| Professional | | $134.90 | $245.47 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.49 / $380.19 / $7,079.46
| Facility | | $117.49 | $380.19 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $338.84 / $478.63
| Professional | | $234.42 | $338.84 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $3,162.28 / $8,511.38
| Facility | | $616.60 | $3,162.28 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $263.03 / $549.54
| Professional | | $134.90 | $263.03 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $6,165.95 / $6,165.95
| Facility | | $6,165.95 | $6,165.95 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $3,630.78 / $19,498.45
| Facility | | $316.23 | $3,630.78 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $251.19 / $1,548.82
| Professional | | $125.89 | $251.19 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $3,548.13 / $8,511.38
| Facility | | $676.08 | $3,548.13 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $245.47 / $524.81
| Professional | | $125.89 | $245.47 | $524.81 |