- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.89 / $2,238.72 / $3,801.89
| Facility | | $125.89 | $2,238.72 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $125.89 / $407.38
| Professional | | $91.20 | $125.89 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $575.44 / $2,818.38
| Facility | | $56.23 | $575.44 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $165.96 / $363.08
| Professional | | $93.33 | $165.96 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.65 / $109.65 / $251.19
| Facility | | $109.65 | $109.65 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $199.53 / $416.87
| Professional | | $128.82 | $199.53 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $85.11 / $177.83 / $7,079.46
| Facility | | $85.11 | $177.83 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $147.91 / $218.78
| Professional | | $77.62 | $147.91 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,041.74 / $3,467.37
| Facility | | $630.96 | $2,041.74 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $173.78 / $331.13
| Professional | | $102.33 | $173.78 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $512.86 / $512.86
| Facility | | $512.86 | $512.86 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $602.56 / $2,818.38
| Facility | | $56.23 | $602.56 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $165.96 / $363.08
| Professional | | $93.33 | $165.96 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,819.70 / $2,818.38
| Facility | | $501.19 | $1,819.70 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $186.21 / $354.81
| Professional | | $107.15 | $186.21 | $354.81 |