- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $193.78 / $565.84 / $1,585.73
| Facility | | $193.78 | $565.84 | $1,585.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.86 / $213.15 / $274.52
| Professional | | $180.86 | $213.15 | $274.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $306.07 / $788.02 / $1,669.70
| Facility | | $306.07 | $788.02 | $1,669.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $322.95 / $322.95 / $875.59
| Professional | | $322.95 | $322.95 | $875.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $290.66 / $403.70 / $565.17
| Facility | | $290.66 | $403.70 | $565.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $80.00 / $80.00
| Facility | | $80.00 | $80.00 | $80.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.48 / $738.25 / $1,438.89
| Facility | | $229.48 | $738.25 | $1,438.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.17 / $393.13 / $471.01
| Professional | | $171.17 | $393.13 | $471.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $516.74 / $1,534.06 / $1,534.06
| Facility | | $516.74 | $1,534.06 | $1,534.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,614.80 / $1,614.80 / $2,422.19
| Professional | | $1,614.80 | $1,614.80 | $2,422.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $193.78 / $322.95 / $481.21
| Facility | | $193.78 | $322.95 | $481.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.81 / $322.95 / $403.70
| Professional | | $306.81 | $322.95 | $403.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $219.37 / $350.99 / $1,172.00
| Facility | | $219.37 | $350.99 | $1,172.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.93 / $387.55 / $465.06
| Professional | | $209.93 | $387.55 | $465.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.63 / $150.72 / $215.31
| Professional | | $135.63 | $150.72 | $215.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.95 / $125.95 / $322.95
| Professional | | $5.95 | $125.95 | $322.95 |