- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $435.35 / $1,152.08 / $2,304.17
| Facility | | $435.35 | $1,152.08 | $2,304.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $435.35 / $964.38 / $1,167.09
| Professional | | $435.35 | $964.38 | $1,167.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.79 / $127.54 / $308.64
| Professional | | $103.79 | $127.54 | $308.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $231.15 / $231.15 / $14,648.00
| Facility | | $231.15 | $231.15 | $14,648.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.46 / $210.61 / $778.00
| Professional | | $151.46 | $210.61 | $778.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.41 / $244.41 / $244.41
| Professional | | $244.41 | $244.41 | $244.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.26 / $245.08 / $773.65
| Professional | | $197.26 | $245.08 | $773.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $231.15 / $231.15 / $597.00
| Facility | | $231.15 | $231.15 | $597.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.46 / $210.61 / $778.00
| Professional | | $151.46 | $210.61 | $778.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.68 / $1,026.72 / $2,149.14
| Professional | | $194.68 | $1,026.72 | $2,149.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $197.26 / $197.26 / $925.77
| Facility | | $197.26 | $197.26 | $925.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.26 / $245.08 / $925.77
| Professional | | $197.26 | $245.08 | $925.77 |