- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $378.25 / $378.25 / $406.49
| Facility | | $378.25 | $378.25 | $406.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $348.61 / $378.25 / $517.10
| Professional | | $348.61 | $378.25 | $517.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $470.55 / $1,355.76 / $3,040.74
| Facility | | $470.55 | $1,355.76 | $3,040.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.43 / $555.20 / $2,725.60
| Professional | | $315.43 | $555.20 | $2,725.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $378.15 / $2,010.39 / $3,770.54
| Facility | | $378.15 | $2,010.39 | $3,770.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,376.38 / $3,675.65 / $5,779.28
| Facility | | $1,376.38 | $3,675.65 | $5,779.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $393.69 / $794.43 / $1,375.98
| Professional | | $393.69 | $794.43 | $1,375.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.85 / $839.02 / $6,679.00
| Facility | | $371.85 | $839.02 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.03 / $501.00 / $752.01
| Professional | | $45.03 | $501.00 | $752.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $487.42 / $942.15 / $2,305.60
| Professional | | $487.42 | $942.15 | $2,305.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $844.97 / $4,042.45 / $4,042.45
| Facility | | $844.97 | $4,042.45 | $4,042.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $265.10 / $638.48 / $2,725.60
| Professional | | $265.10 | $638.48 | $2,725.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $265.10 / $546.26 / $1,283.46
| Professional | | $265.10 | $546.26 | $1,283.46 |