- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $2,454.71 / $8,317.64
| Facility | | $239.88 | $2,454.71 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $194.98 / $537.03
| Professional | | $117.49 | $194.98 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $186.21 / $316.23
| Professional | | $151.36 | $186.21 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $5,248.07 / $57,543.99
| Facility | | $5,011.87 | $5,248.07 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $245.47 / $288.40
| Professional | | $204.17 | $245.47 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $177.83 / $309.03
| Professional | | $125.89 | $177.83 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $288.40 / $316.23
| Professional | | $223.87 | $288.40 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $208.93 / $309.03
| Professional | | $117.49 | $208.93 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $6,025.60 / $8,709.64
| Facility | | $933.25 | $6,025.60 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $1,995.26 / $7,762.47
| Facility | | $354.81 | $1,995.26 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $208.93 / $467.74
| Professional | | $117.49 | $208.93 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $151.36 / $416.87
| Facility | | $151.36 | $151.36 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $257.04 / $389.05
| Professional | | $154.88 | $257.04 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.33 / $131.83 / $588.84
| Facility | | $102.33 | $131.83 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $186.21 / $588.84
| Professional | | $102.33 | $186.21 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $2,754.23 / $6,606.93
| Facility | | $912.01 | $2,754.23 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $158.49 / $275.42
| Professional | | $117.49 | $158.49 | $275.42 |