- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $161.85 / $303.52 / $5,597.36
| Facility | | $161.85 | $303.52 | $5,597.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.62 / $249.37 / $355.80
| Professional | | $155.62 | $249.37 | $355.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.02 / $494.73 / $894.02
| Professional | | $286.02 | $494.73 | $894.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $172.93 / $388.96 / $707.31
| Facility | | $172.93 | $388.96 | $707.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.86 / $566.73 / $2,315.04
| Professional | | $296.86 | $566.73 | $2,315.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $397.00 / $642.76 / $2,532.54
| Facility | | $397.00 | $642.76 | $2,532.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.09 / $464.78 / $739.23
| Professional | | $363.09 | $464.78 | $739.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.14 / $386.05 / $596.50
| Professional | | $255.14 | $386.05 | $596.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,000.00 / $2,000.00 / $2,000.00
| Facility | | $2,000.00 | $2,000.00 | $2,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.86 / $539.74 / $822.47
| Professional | | $296.86 | $539.74 | $822.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $339.50 / $415.40 / $734.90
| Professional | | $339.50 | $415.40 | $734.90 |