- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $311.45 / $710.44 / $10,477.45
| Facility | | $311.45 | $710.44 | $10,477.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.37 / $449.98 / $801.76
| Professional | | $227.37 | $449.98 | $801.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.48 / $238.48 / $238.48
| Professional | | $238.48 | $238.48 | $238.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $305.14 / $560.90 / $1,230.67
| Professional | | $305.14 | $560.90 | $1,230.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $2,062.80
| Facility | | $606.10 | $606.10 | $2,062.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.85 / $530.76 / $1,001.36
| Professional | | $285.85 | $530.76 | $1,001.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $240.84 / $518.71 / $779.63
| Facility | | $240.84 | $518.71 | $779.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $555.39 / $591.00 / $606.00
| Professional | | $555.39 | $591.00 | $606.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $617.60 / $1,326.40
| Professional | | $3.00 | $617.60 | $1,326.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,206.00 / $6,575.00 / $9,616.00
| Facility | | $2,206.00 | $6,575.00 | $9,616.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $392.66 / $564.44 / $1,135.96
| Professional | | $392.66 | $564.44 | $1,135.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,141.76 / $1,253.91 / $26,542.00
| Facility | | $1,141.76 | $1,253.91 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,801.68 / $3,333.44 / $3,945.08
| Professional | | $1,801.68 | $3,333.44 | $3,945.08 |