- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $332.35 / $671.59 / $671.59
| Facility | | $332.35 | $671.59 | $671.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $423.85 / $776.04 / $2,858.58
| Professional | | $423.85 | $776.04 | $2,858.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.66 / $1,195.33 / $9,011.04
| Facility | | $104.66 | $1,195.33 | $9,011.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.96 / $994.80 / $4,824.77
| Professional | | $245.96 | $994.80 | $4,824.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $901.48 / $1,563.29 / $3,126.58
| Facility | | $901.48 | $1,563.29 | $3,126.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.05 / $1,947.64 / $5,792.39
| Facility | | $660.05 | $1,947.64 | $5,792.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.63 / $441.07 / $815.10
| Professional | | $259.63 | $441.07 | $815.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.38 / $528.54 / $8,090.00
| Facility | | $294.38 | $528.54 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.36 / $397.41 / $690.68
| Professional | | $49.36 | $397.41 | $690.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $314.16 / $632.72 / $835.04
| Professional | | $314.16 | $632.72 | $835.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $531.44 / $9,011.04 / $9,011.04
| Facility | | $531.44 | $9,011.04 | $9,011.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.32 / $2,384.81 / $5,028.91
| Professional | | $328.32 | $2,384.81 | $5,028.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $312.89 / $1,840.03 / $5,330.77
| Professional | | $312.89 | $1,840.03 | $5,330.77 |