- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $315.63 / $676.28 / $676.28
| Facility | | $315.63 | $676.28 | $676.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $430.03 / $784.57 / $1,427.98
| Professional | | $430.03 | $784.57 | $1,427.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.13 / $1,129.79 / $3,586.95
| Facility | | $151.13 | $1,129.79 | $3,586.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.72 / $940.25 / $2,683.39
| Professional | | $235.72 | $940.25 | $2,683.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $800.80 / $1,563.29 / $3,126.58
| Facility | | $800.80 | $1,563.29 | $3,126.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $640.30 / $1,878.44 / $2,893.01
| Facility | | $640.30 | $1,878.44 | $2,893.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.01 / $430.41 / $794.13
| Professional | | $255.01 | $430.41 | $794.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $261.10 / $468.81 / $8,090.00
| Facility | | $261.10 | $468.81 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.89 / $362.19 / $637.41
| Professional | | $70.89 | $362.19 | $637.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $307.20 / $618.70 / $816.54
| Professional | | $307.20 | $618.70 | $816.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $521.89 / $3,586.95 / $3,586.95
| Facility | | $521.89 | $3,586.95 | $3,586.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.06 / $2,361.17 / $3,831.56
| Professional | | $317.06 | $2,361.17 | $3,831.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.92 / $1,859.88 / $3,878.50
| Professional | | $306.92 | $1,859.88 | $3,878.50 |