- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $2,187.76 / $3,801.89
| Facility | | $275.42 | $2,187.76 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $346.74 / $954.99
| Professional | | $190.55 | $346.74 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $1,513.56 / $3,890.45
| Facility | | $436.52 | $1,513.56 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $331.13 / $2,041.74
| Professional | | $181.97 | $331.13 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $234.42 / $537.03
| Facility | | $234.42 | $234.42 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $407.38 / $645.65
| Professional | | $234.42 | $407.38 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $426.58 / $501.19
| Facility | | $100.00 | $426.58 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $363.08 / $707.95
| Professional | | $194.98 | $363.08 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $316.23 / $7,079.46
| Facility | | $177.83 | $316.23 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $489.78 / $676.08
| Professional | | $354.81 | $489.78 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $1,949.84 / $7,079.46
| Facility | | $346.74 | $1,949.84 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $416.87 / $851.14
| Professional | | $239.88 | $416.87 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $812.83 / $1,202.26
| Facility | | $158.49 | $812.83 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $537.03 / $676.08
| Professional | | $269.15 | $537.03 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $1,513.56 / $3,890.45
| Facility | | $436.52 | $1,513.56 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $331.13 / $2,041.74
| Professional | | $181.97 | $331.13 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $2,041.74 / $5,623.41
| Facility | | $467.74 | $2,041.74 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $354.81 / $812.83
| Professional | | $190.55 | $354.81 | $812.83 |