- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $1,174.90 / $1,174.90
| Facility | | $512.86 | $1,174.90 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $346.74 / $512.86
| Professional | | $302.00 | $346.74 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $57.54 / $1,513.56
| Professional | | $48.98 | $57.54 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,380.38 / $2,187.76
| Facility | | $1,174.90 | $1,380.38 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $1,071.52 / $1,348.96
| Professional | | $489.78 | $1,071.52 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $1,737.80 / $2,511.89
| Facility | | $436.52 | $1,737.80 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $2,570.40 / $2,818.38
| Professional | | $2,570.40 | $2,570.40 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $549.54 / $1,479.11
| Facility | | $380.19 | $549.54 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $257.04 / $2,137.96
| Professional | | $190.55 | $257.04 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $64.57 / $85.11
| Professional | | $50.12 | $64.57 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,000.00 / $1,412.54
| Professional | | $691.83 | $1,000.00 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $2,041.74 / $2,041.74
| Facility | | $851.14 | $2,041.74 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $2,137.96 / $2,137.96
| Professional | | $616.60 | $2,137.96 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $912.01 / $912.01
| Professional | | $912.01 | $912.01 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $2,344.23 / $3,235.94
| Professional | | $1,230.27 | $2,344.23 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $338.84 / $512.86
| Facility | | $338.84 | $338.84 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $257.04 / $707.95
| Professional | | $177.83 | $257.04 | $707.95 |