- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.95 / $4,073.80 / $7,762.47
| Facility | | $0.95 | $4,073.80 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $131.83 / $446.68
| Professional | | $91.20 | $131.83 | $446.68 |
- 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
- $109.65 / $181.97 / $549.54
| Professional | | $109.65 | $181.97 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $295.12 / $467.74
| Facility | | $251.19 | $295.12 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $354.81 / $407.38
| Professional | | $158.49 | $354.81 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $2,630.27 / $5,128.61
| Facility | | $104.71 | $2,630.27 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $239.88 / $281.84
| Professional | | $173.78 | $239.88 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $1,445.44 / $3,235.94
| Facility | | $104.71 | $1,445.44 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $213.80 / $630.96
| Professional | | $120.23 | $213.80 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $70.79
| Professional | | $32.36 | $33.11 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $218.78 / $302.00
| Professional | | $107.15 | $218.78 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $3,019.95 / $4,466.84
| Facility | | $3,019.95 | $3,019.95 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $398.11 / $707.95
| Professional | | $177.83 | $398.11 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $489.78 / $630.96
| Professional | | $346.74 | $489.78 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,584.89 / $2,187.76
| Facility | | $1,023.29 | $1,584.89 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $177.83 / $512.86
| Professional | | $109.65 | $177.83 | $512.86 |