- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $2,238.72 / $3,801.89
| Facility | | $190.55 | $2,238.72 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $194.98 / $371.54
| Professional | | $128.82 | $194.98 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $4,265.80 / $19,498.45
| Facility | | $323.59 | $4,265.80 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $234.42 / $630.96
| Professional | | $138.04 | $234.42 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.88 / $154.88 / $354.81
| Facility | | $154.88 | $154.88 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $269.15 / $478.63
| Professional | | $154.88 | $269.15 | $478.63 |
- 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
- $158.49 / $302.00 / $524.81
| Professional | | $158.49 | $302.00 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.23 / $380.19 / $7,079.46
| Facility | | $120.23 | $380.19 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $288.40 / $389.05
| Professional | | $223.87 | $288.40 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $3,630.78 / $8,511.38
| Facility | | $1,258.93 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $239.88 / $512.86
| Professional | | $138.04 | $239.88 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,000.00
| Facility | | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $218.78 / $316.23
| Professional | | $218.78 | $218.78 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $4,265.80 / $19,498.45
| Facility | | $323.59 | $4,265.80 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $234.42 / $602.56
| Professional | | $138.04 | $234.42 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $3,630.78 / $8,511.38
| Facility | | $1,258.93 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $239.88 / $512.86
| Professional | | $138.04 | $239.88 | $512.86 |