- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.61 / $98.61 / $1,629.72
| Professional | | $98.61 | $98.61 | $1,629.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.47 / $602.47 / $620.16
| Facility | | $602.47 | $602.47 | $620.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,120.99 / $1,309.97 / $2,009.53
| Facility | | $1,120.99 | $1,309.97 | $2,009.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $482.39 / $1,097.13 / $1,246.74
| Professional | | $482.39 | $1,097.13 | $1,246.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $313.72 / $488.92 / $1,426.01
| Facility | | $313.72 | $488.92 | $1,426.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $366.69 / $488.92 / $1,426.01
| Facility | | $366.69 | $488.92 | $1,426.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.26 / $158.44 / $760.23
| Professional | | $123.26 | $158.44 | $760.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.00 / $70.00 / $85.00
| Professional | | $50.00 | $70.00 | $85.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $313.72 / $488.92 / $1,426.01
| Facility | | $313.72 | $488.92 | $1,426.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $468.20 / $970.20 / $1,363.07
| Professional | | $468.20 | $970.20 | $1,363.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $814.86 / $1,935.29 / $1,935.29
| Facility | | $814.86 | $1,935.29 | $1,935.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,629.72 / $1,629.72 / $2,029.00
| Professional | | $1,629.72 | $1,629.72 | $2,029.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $867.64 / $867.64 / $867.64
| Professional | | $867.64 | $867.64 | $867.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,184.08 / $2,224.57 / $2,224.57
| Professional | | $1,184.08 | $2,224.57 | $2,224.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.68 / $171.12 / $591.83
| Professional | | $132.68 | $171.12 | $591.83 |