- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $2,630.27 / $7,413.10
| Facility | | $234.42 | $2,630.27 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $251.19 / $562.34
| Professional | | $169.82 | $251.19 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $4,786.30 / $10,232.93
| Facility | | $2,630.27 | $4,786.30 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $257.04 / $575.44
| Professional | | $208.93 | $257.04 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $1,258.93 / $4,073.80
| Facility | | $234.42 | $1,258.93 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $234.42 / $323.59
| Professional | | $234.42 | $234.42 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $1,318.26 / $50,118.72
| Facility | | $288.40 | $1,318.26 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $346.74 / $831.76
| Professional | | $181.97 | $346.74 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.86 / $186.21 / $436.52
| Facility | | $75.86 | $186.21 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $354.81 / $512.86
| Professional | | $263.03 | $354.81 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $331.13 / $489.78
| Professional | | $194.98 | $331.13 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $3,467.37 / $3,467.37
| Facility | | $3,467.37 | $3,467.37 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $50,118.72 / $75,857.76
| Facility | | $177.83 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $338.84 / $478.63
| Professional | | $275.42 | $338.84 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $3,890.45 / $8,317.64
| Facility | | $1,862.09 | $3,890.45 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $223.87 / $575.44
| Professional | | $141.25 | $223.87 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $223.87 / $501.19
| Facility | | $138.04 | $223.87 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $309.03 / $489.78
| Professional | | $190.55 | $309.03 | $489.78 |