- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $250.12 / $834.82 / $1,962.11
| Facility | | $250.12 | $834.82 | $1,962.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.88 / $256.14 / $1,937.68
| Professional | | $195.88 | $256.14 | $1,937.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $262.63 / $601.19 / $1,485.66
| Facility | | $262.63 | $601.19 | $1,485.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.54 / $282.37 / $691.44
| Professional | | $120.54 | $282.37 | $691.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.00 / $455.04 / $828.71
| Facility | | $97.00 | $455.04 | $828.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.12 / $195.88 / $492.42
| Professional | | $137.12 | $195.88 | $492.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.85 / $505.37 / $1,008.78
| Facility | | $204.85 | $505.37 | $1,008.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.50 / $250.82 / $914.80
| Professional | | $159.50 | $250.82 | $914.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.08 / $301.35 / $406.82
| Professional | | $241.08 | $301.35 | $406.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.22 / $346.55 / $656.94
| Professional | | $271.22 | $346.55 | $656.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.35 / $1,431.41 / $1,431.41
| Facility | | $524.35 | $1,431.41 | $1,431.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,506.75 / $1,506.75 / $2,260.13
| Professional | | $1,506.75 | $1,506.75 | $2,260.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $241.08 / $361.62 / $864.42
| Facility | | $241.08 | $361.62 | $864.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.87 / $346.55 / $814.69
| Professional | | $161.87 | $346.55 | $814.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,057.73 / $1,057.73 / $1,057.73
| Professional | | $1,057.73 | $1,057.73 | $1,057.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.08 / $271.22 / $409.84
| Professional | | $241.08 | $271.22 | $409.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.57 / $135.61 / $933.07
| Professional | | $126.57 | $135.61 | $933.07 |