- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.20 / $1,737.80 / $7,244.36
| Facility | | $91.20 | $1,737.80 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $165.96 / $398.11
| Professional | | $70.79 | $165.96 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,570.40 / $2,951.21
| Facility | | $2,137.96 | $2,570.40 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $177.83 / $346.74
| Professional | | $77.62 | $177.83 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $77.62 / $1,737.80
| Professional | | $67.61 | $77.62 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $512.86 / $616.60
| Facility | | $457.09 | $512.86 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $190.55 / $354.81
| Professional | | $79.43 | $190.55 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $288.40 / $616.60
| Professional | | $239.88 | $288.40 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $512.86 / $512.86
| Professional | | $281.84 | $512.86 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $77.62 / $186.21 / $371.54
| Facility | | $77.62 | $186.21 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $104.71 / $104.71
| Professional | | $104.71 | $104.71 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $72.44 / $91.20 / $389.05
| Facility | | $72.44 | $91.20 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $239.88 / $891.25
| Professional | | $190.55 | $239.88 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $2,818.38 / $5,754.40
| Facility | | $512.86 | $2,818.38 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $151.36 / $323.59
| Professional | | $69.18 | $151.36 | $323.59 |