- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $2,187.76 / $3,801.89
| Facility | | $162.18 | $2,187.76 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $169.82 / $602.56
| Professional | | $109.65 | $169.82 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,288.25 / $3,548.13
| Facility | | $56.23 | $1,288.25 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $229.09 / $524.81
| Professional | | $128.82 | $229.09 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $138.04 / $316.23
| Facility | | $138.04 | $138.04 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $316.23 / $575.44
| Professional | | $186.21 | $316.23 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $263.03 / $549.54
| Professional | | $158.49 | $263.03 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.65 / $218.78 / $7,079.46
| Facility | | $109.65 | $218.78 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $204.17 / $316.23
| Professional | | $112.20 | $204.17 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $2,511.89 / $7,079.46
| Facility | | $1,096.48 | $2,511.89 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $229.09 / $467.74
| Professional | | $131.83 | $229.09 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $144.54 / $933.25
| Facility | | $144.54 | $144.54 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $316.23 / $316.23
| Professional | | $316.23 | $316.23 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,288.25 / $3,548.13
| Facility | | $56.23 | $1,288.25 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $223.87 / $512.86
| Professional | | $128.82 | $223.87 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $2,454.71 / $6,165.95
| Facility | | $1,047.13 | $2,454.71 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $239.88 / $489.78
| Professional | | $144.54 | $239.88 | $489.78 |