- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $588.84 / $1,862.09
| Facility | | $245.47 | $588.84 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $295.12 / $380.19
| Professional | | $100.00 | $295.12 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $562.34 / $891.25
| Facility | | $194.98 | $562.34 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $407.38 / $407.38
| Professional | | $407.38 | $407.38 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.43 / $79.43 / $79.43
| Facility | | $79.43 | $79.43 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.82 / $309.03 / $1,819.70
| Facility | | $114.82 | $309.03 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $501.19 / $588.84
| Professional | | $79.43 | $501.19 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $1,949.84 / $1,949.84
| Facility | | $1,949.84 | $1,949.84 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $3,090.30 / $3,090.30
| Professional | | $2,041.74 | $3,090.30 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $416.87 / $812.83
| Facility | | $269.15 | $416.87 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $309.03 / $489.78
| Professional | | $229.09 | $309.03 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $436.52 / $870.96
| Professional | | $407.38 | $436.52 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.91 / $407.38 / $1,122.02
| Facility | | $147.91 | $407.38 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $426.58 / $707.95
| Professional | | $79.43 | $426.58 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.91 / $169.82 / $407.38
| Facility | | $147.91 | $169.82 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $69.18 / $165.96
| Professional | | $69.18 | $69.18 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $407.38 / $407.38
| Professional | | $64.57 | $407.38 | $407.38 |