- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $2,187.76 / $3,801.89
| Facility | | $251.19 | $2,187.76 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $245.47 / $524.81
| Professional | | $114.82 | $245.47 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $630.96 / $2,754.23
| Facility | | $56.23 | $630.96 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $302.00 / $831.76
| Professional | | $112.20 | $302.00 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $138.04 / $323.59
| Facility | | $138.04 | $138.04 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $316.23 / $588.84
| Professional | | $138.04 | $316.23 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $50.12 / $208.93
| Facility | | $50.12 | $50.12 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $363.08 / $707.95
| Professional | | $147.91 | $363.08 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.33 / $218.78 / $7,079.46
| Facility | | $102.33 | $218.78 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $354.81 / $501.19
| Professional | | $288.40 | $354.81 | $501.19 |
- 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
- $120.23 / $288.40 / $660.69
| Professional | | $120.23 | $288.40 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $416.87 / $416.87
| Professional | | $416.87 | $416.87 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $691.83 / $2,818.38
| Facility | | $56.23 | $691.83 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $302.00 / $831.76
| Professional | | $112.20 | $302.00 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,819.70 / $2,818.38
| Facility | | $501.19 | $1,819.70 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $281.84 / $645.65
| Professional | | $120.23 | $281.84 | $645.65 |