- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $2,238.72 / $4,168.69
| Facility | | $218.78 | $2,238.72 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $229.09 / $575.44
| Professional | | $173.78 | $229.09 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $1,862.09 / $19,498.45
| Facility | | $416.87 | $1,862.09 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $288.40 / $707.95
| Professional | | $165.96 | $288.40 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $208.93 / $478.63
| Facility | | $208.93 | $208.93 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $363.08 / $794.33
| Professional | | $263.03 | $363.08 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $323.59 / $537.03
| Professional | | $194.98 | $323.59 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $380.19 / $7,079.46
| Facility | | $173.78 | $380.19 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $323.59 / $436.52
| Professional | | $257.04 | $323.59 | $436.52 |
- 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
- $204.17 / $338.84 / $602.56
| Professional | | $204.17 | $338.84 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $1,584.89 / $2,089.30
| Facility | | $1,584.89 | $1,584.89 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $724.44 / $776.25
| Professional | | $389.05 | $724.44 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $1,862.09 / $19,498.45
| Facility | | $416.87 | $1,862.09 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $288.40 / $707.95
| Professional | | $165.96 | $288.40 | $707.95 |
- 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
- $190.55 / $323.59 / $602.56
| Professional | | $190.55 | $323.59 | $602.56 |