- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $691.83 / $7,585.78
| Facility | | $208.93 | $691.83 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $398.11 / $758.58
| Professional | | $123.03 | $398.11 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $524.81 / $1,122.02
| Professional | | $147.91 | $524.81 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $758.58 / $2,290.87
| Facility | | $218.78 | $758.58 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $380.19 / $891.25
| Professional | | $147.91 | $380.19 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $630.96 / $630.96
| Professional | | $630.96 | $630.96 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.03 / $371.54 / $724.44
| Facility | | $123.03 | $371.54 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $199.53 / $199.53
| Professional | | $199.53 | $199.53 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $616.60 / $1,174.90
| Professional | | $186.21 | $616.60 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $3,890.45 / $9,549.93
| Facility | | $912.01 | $3,890.45 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $331.13 / $630.96
| Professional | | $120.23 | $331.13 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $7,943.28 / $19,498.45
| Facility | | $7,943.28 | $7,943.28 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,090.30 / $3,715.35
| Professional | | $3,090.30 | $3,090.30 | $3,715.35 |