- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.23 / $2,187.76 / $3,801.89
| Facility | | $120.23 | $2,187.76 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $138.04 / $338.84
| Professional | | $91.20 | $138.04 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $2,398.83 / $19,498.45
| Facility | | $213.80 | $2,398.83 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $162.18 / $371.54
| Professional | | $91.20 | $162.18 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.33 / $102.33 / $234.42
| Facility | | $102.33 | $102.33 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $177.83 / $281.84
| Professional | | $102.33 | $177.83 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $676.08 / $2,137.96 / $2,137.96
| Professional | 50 | $676.08 | $2,137.96 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $1,584.89 / $1,584.89
| Facility | | $1,584.89 | $1,584.89 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $194.98 / $338.84
| Professional | | $114.82 | $194.98 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $380.19 / $7,079.46
| Facility | | $83.18 | $380.19 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $173.78 / $234.42
| Professional | | $138.04 | $173.78 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,862.09 / $3,467.37
| Facility | | $501.19 | $1,862.09 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $144.54 / $316.23
| Professional | | $85.11 | $144.54 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $169.82 / $190.55
| Professional | | $162.18 | $169.82 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $2,691.53 / $19,498.45
| Facility | | $213.80 | $2,691.53 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $162.18 / $371.54
| Professional | | $91.20 | $162.18 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,862.09 / $4,168.69
| Facility | | $501.19 | $1,862.09 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $165.96 / $323.59
| Professional | | $104.71 | $165.96 | $323.59 |