- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $2,691.53 / $5,623.41
| Facility | | $281.84 | $2,691.53 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $281.84 / $954.99
| Professional | | $131.83 | $281.84 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $3,981.07 / $28,840.32
| Facility | | $316.23 | $3,981.07 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $346.74 / $912.01
| Professional | | $141.25 | $346.74 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $151.36 / $354.81
| Facility | | $151.36 | $151.36 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $489.78 / $1,122.02
| Professional | | $263.03 | $489.78 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $363.08 / $870.96
| Professional | | $173.78 | $363.08 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.03 / $501.19 / $7,079.46
| Facility | | $123.03 | $501.19 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $331.13 / $489.78
| Professional | | $177.83 | $331.13 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $4,265.80 / $9,772.37
| Facility | | $1,995.26 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $338.84 / $724.44
| Professional | | $144.54 | $338.84 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,890.45 / $5,248.07
| Facility | | $3,090.30 | $3,890.45 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $537.03 / $562.34
| Professional | | $144.54 | $537.03 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $4,265.80 / $28,840.32
| Facility | | $316.23 | $4,265.80 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $346.74 / $912.01
| Professional | | $141.25 | $346.74 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $3,981.07 / $9,120.11
| Facility | | $1,862.09 | $3,981.07 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $354.81 / $758.58
| Professional | | $151.36 | $354.81 | $758.58 |