- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $2,691.53 / $3,715.35
| Facility | | $204.17 | $2,691.53 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $204.17 / $660.69
| Professional | | $125.89 | $204.17 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $707.95 / $2,818.38
| Facility | | $56.23 | $707.95 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $257.04 / $645.65
| Professional | | $151.36 | $257.04 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $177.83 / $407.38
| Facility | | $177.83 | $177.83 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $380.19 / $630.96
| Professional | | $223.87 | $380.19 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $288.40 / $616.60
| Professional | | $169.82 | $288.40 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $218.78 / $7,079.46
| Facility | | $128.82 | $218.78 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $257.04 / $416.87
| Professional | | $141.25 | $257.04 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,041.74 / $3,467.37
| Facility | | $630.96 | $2,041.74 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $281.84 / $588.84
| Professional | | $154.88 | $281.84 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $707.95 / $741.31
| Facility | | $575.44 | $707.95 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $234.42 / $245.47
| Professional | | $234.42 | $234.42 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $707.95 / $2,818.38
| Facility | | $56.23 | $707.95 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $257.04 / $645.65
| Professional | | $151.36 | $257.04 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,819.70 / $2,818.38
| Facility | | $501.19 | $1,819.70 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $281.84 / $602.56
| Professional | | $154.88 | $281.84 | $602.56 |