- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $2,344.23 / $7,762.47
| Facility | | $426.58 | $2,344.23 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $186.21 / $575.44
| Professional | | $102.33 | $186.21 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $169.82 / $245.47
| Professional | | $112.20 | $169.82 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,398.83 / $57,543.99
| Facility | | $2,344.23 | $2,398.83 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $229.09 / $323.59
| Professional | | $154.88 | $229.09 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $169.82 / $281.84
| Professional | | $112.20 | $169.82 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $251.19 / $275.42
| Professional | | $194.98 | $251.19 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $194.98 / $288.40
| Professional | | $123.03 | $194.98 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,202.26 / $1,905.46
| Facility | | $812.83 | $1,202.26 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $1,905.46 / $7,244.36
| Facility | | $537.03 | $1,905.46 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $190.55 / $446.68
| Professional | | $109.65 | $190.55 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $218.78 / $338.84
| Facility | | $218.78 | $218.78 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $257.04 / $338.84
| Professional | | $181.97 | $257.04 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.83 / $134.90 / $173.78
| Facility | | $131.83 | $134.90 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $134.90 / $407.38
| Professional | | $107.15 | $134.90 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $812.83 / $3,890.45
| Facility | | $223.87 | $812.83 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $158.49 / $251.19
| Professional | | $112.20 | $158.49 | $251.19 |