- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $1,737.80 / $3,311.31
| Facility | | $234.42 | $1,737.80 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $194.98 / $489.78
| Professional | | $109.65 | $194.98 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,090.30 / $5,754.40
| Facility | | $1,584.89 | $3,090.30 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $234.42 / $588.84
| Professional | | $151.36 | $234.42 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $524.81 / $831.76
| Facility | | $446.68 | $524.81 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $426.58 / $758.58
| Professional | | $181.97 | $426.58 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.65 / $218.78 / $3,162.28
| Facility | | $109.65 | $218.78 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $309.03 / $467.74
| Professional | | $208.93 | $309.03 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.82 / $234.42 / $3,311.31
| Facility | | $114.82 | $234.42 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $338.84 / $1,258.93
| Professional | | $177.83 | $338.84 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $151.36
| Professional | | $32.36 | $33.11 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $338.84 / $562.34
| Professional | | $199.53 | $338.84 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,445.44 / $2,089.30
| Facility | | $758.58 | $1,445.44 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $831.76 / $1,230.27
| Professional | | $213.80 | $831.76 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $660.69 / $977.24
| Professional | | $158.49 | $660.69 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,818.38 / $4,677.35
| Facility | | $2,238.72 | $2,818.38 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $229.09 / $616.60
| Professional | | $123.03 | $229.09 | $616.60 |