- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $2,691.53 / $8,317.64
| Facility | | $537.03 | $2,691.53 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $269.15 / $707.95
| Professional | | $141.25 | $269.15 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $269.15 / $446.68
| Professional | | $190.55 | $269.15 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $8,511.38 / $77,624.71
| Facility | | $5,011.87 | $8,511.38 | $77,624.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $269.15 / $446.68
| Professional | | $229.09 | $269.15 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $234.42 / $416.87
| Professional | | $154.88 | $234.42 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $295.12 / $416.87
| Professional | | $151.36 | $295.12 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $281.84 / $436.52
| Professional | | $138.04 | $281.84 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $2,511.89 / $2,511.89
| Facility | | $2,511.89 | $2,511.89 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $2,089.30 / $7,762.47
| Facility | | $537.03 | $2,089.30 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $269.15 / $616.60
| Professional | | $147.91 | $269.15 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $151.36 / $549.54
| Facility | | $151.36 | $151.36 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $363.08 / $549.54
| Professional | | $158.49 | $363.08 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.91 / $158.49 / $309.03
| Facility | | $8.91 | $158.49 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.91 / $169.82 / $346.74
| Professional | | $8.91 | $169.82 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $2,089.30 / $6,309.57
| Facility | | $177.83 | $2,089.30 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $194.98 / $346.74
| Professional | | $128.82 | $194.98 | $346.74 |