- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $2,951.21 / $7,762.47
| Facility | | $245.47 | $2,951.21 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $223.87 / $602.56
| Professional | | $165.96 | $223.87 | $602.56 |
- 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
- $223.87 / $275.42 / $549.54
| Professional | | $223.87 | $275.42 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $1,258.93 / $4,073.80
| Facility | | $263.03 | $1,258.93 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $263.03 / $338.84
| Professional | | $263.03 | $263.03 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $1,318.26 / $50,118.72
| Facility | | $316.23 | $1,318.26 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $346.74 / $870.96
| Professional | | $199.53 | $346.74 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $223.87 / $645.65
| Facility | | $190.55 | $223.87 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $346.74 / $501.19
| Professional | | $257.04 | $346.74 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $316.23 / $524.81
| Professional | | $173.78 | $316.23 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $50,118.72 / $75,857.76
| Facility | | $181.97 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $338.84 / $501.19
| Professional | | $275.42 | $338.84 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $4,365.16 / $9,549.93
| Facility | | $2,137.96 | $4,365.16 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $275.42 / $562.34
| Professional | | $186.21 | $275.42 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $213.80 / $588.84
| Facility | | $151.36 | $213.80 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $295.12 / $645.65
| Professional | | $173.78 | $295.12 | $645.65 |