- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $212.94 / $870.78 / $8,905.57
| Facility | | $212.94 | $870.78 | $8,905.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.09 / $446.18 / $974.40
| Professional | | $139.09 | $446.18 | $974.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.86 / $231.98 / $295.72
| Professional | | $147.86 | $231.98 | $295.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.74 / $822.15 / $1,521.98
| Professional | | $246.74 | $822.15 | $1,521.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $283.56 / $283.56 / $283.56
| Facility | | $283.56 | $283.56 | $283.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.80 / $568.49 / $1,466.16
| Professional | | $187.80 | $568.49 | $1,466.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $164.17 / $712.88 / $1,192.66
| Facility | | $164.17 | $712.88 | $1,192.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $714.00 / $714.00 / $930.00
| Professional | | $714.00 | $714.00 | $930.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.82 / $342.30 / $1,166.23
| Professional | | $229.82 | $342.30 | $1,166.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $750.00 / $3,456.00 / $5,919.00
| Facility | | $750.00 | $3,456.00 | $5,919.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $572.66 / $864.10 / $1,822.60
| Professional | | $572.66 | $864.10 | $1,822.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,118.46 / $1,118.46
| Facility | | $55.00 | $1,118.46 | $1,118.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,536.63 / $4,830.88 / $5,696.33
| Professional | | $2,536.63 | $4,830.88 | $5,696.33 |