- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $2,238.72 / $3,801.89
| Facility | | $199.53 | $2,238.72 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $218.78 / $575.44
| Professional | | $162.18 | $218.78 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $4,897.79 / $19,498.45
| Facility | | $457.09 | $4,897.79 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $302.00 / $741.31
| Professional | | $190.55 | $302.00 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $218.78 / $501.19
| Facility | | $218.78 | $218.78 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $588.84 / $794.33
| Professional | | $371.54 | $588.84 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $371.54 / $707.95
| Professional | | $229.09 | $371.54 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $169.82 / $380.19 / $7,079.46
| Facility | | $169.82 | $380.19 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $257.04 / $416.87
| Professional | | $151.36 | $257.04 | $416.87 |
- 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
- $199.53 / $331.13 / $630.96
| Professional | | $199.53 | $331.13 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $1,862.09 / $5,011.87
| Facility | | $1,862.09 | $1,862.09 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $446.68 / $446.68
| Professional | | $446.68 | $446.68 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $4,897.79 / $19,498.45
| Facility | | $457.09 | $4,897.79 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $295.12 / $741.31
| Professional | | $190.55 | $295.12 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $4,265.80 / $9,772.37
| Facility | | $1,862.09 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $323.59 / $691.83
| Professional | | $208.93 | $323.59 | $691.83 |