- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $323.59 / $5,495.41
| Facility | | $141.25 | $323.59 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $316.23 / $616.60
| Professional | | $151.36 | $316.23 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $4,786.30 / $9,332.54
| Facility | | $2,754.23 | $4,786.30 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $512.86 / $1,023.29
| Professional | | $257.04 | $512.86 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,230.27 / $2,951.21
| Facility | | $758.58 | $1,230.27 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $309.03 / $309.03 / $309.03
| Facility | 22 | $309.03 | $309.03 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $660.69 / $1,318.26
| Professional | | $331.13 | $660.69 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $1,174.90 / $2,290.87
| Facility | | $933.25 | $1,174.90 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $602.56 / $1,230.27
| Professional | | $323.59 | $602.56 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $549.54 / $3,981.07
| Facility | | $218.78 | $549.54 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $707.95 / $1,380.38
| Professional | | $363.08 | $707.95 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $4,265.80 / $6,760.83
| Facility | | $2,691.53 | $4,265.80 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $467.74 / $1,071.52
| Professional | | $218.78 | $467.74 | $1,071.52 |