- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $2,187.76 / $3,801.89
| Facility | | $177.83 | $2,187.76 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $194.98 / $457.09
| Professional | | $123.03 | $194.98 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $616.60 / $2,691.53
| Facility | | $56.23 | $616.60 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $239.88 / $1,479.11
| Professional | | $131.83 | $239.88 | $1,479.11 |
- 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
- $190.55 / $295.12 / $537.03
| Professional | | $190.55 | $295.12 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $446.68 / $501.19
| Facility | | $199.53 | $446.68 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $251.19 / $512.86
| Professional | | $141.25 | $251.19 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.49 / $218.78 / $7,079.46
| Facility | | $117.49 | $218.78 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $323.59 / $446.68
| Professional | | $234.42 | $323.59 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $1,819.70 / $3,467.37
| Facility | | $229.09 | $1,819.70 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $257.04 / $537.03
| Professional | | $141.25 | $257.04 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $263.03 / $263.03
| Professional | | $263.03 | $263.03 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $616.60 / $2,691.53
| Facility | | $56.23 | $616.60 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $239.88 / $1,479.11
| Professional | | $131.83 | $239.88 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $1,412.54 / $2,818.38
| Facility | | $309.03 | $1,412.54 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $245.47 / $512.86
| Professional | | $131.83 | $245.47 | $512.86 |