- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $207.05 / $810.26 / $1,257.10
| Facility | | $207.05 | $810.26 | $1,257.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.48 / $207.05 / $347.76
| Professional | | $194.48 | $207.05 | $347.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.55 / $338.25 / $926.12
| Facility | | $218.55 | $338.25 | $926.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.47 / $296.22 / $1,172.99
| Professional | | $177.47 | $296.22 | $1,172.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $422.33 / $649.01 / $1,175.75
| Facility | | $422.33 | $649.01 | $1,175.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $278.04 / $278.04 / $278.04
| Professional | | $278.04 | $278.04 | $278.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $192.26 / $230.71 / $672.91
| Facility | | $192.26 | $230.71 | $672.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.88 / $312.17 / $771.34
| Professional | | $153.88 | $312.17 | $771.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $3,472.00 / $9,239.00
| Facility | | $83.43 | $3,472.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.60 / $426.60 / $501.89
| Professional | | $426.60 | $426.60 | $501.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.79 / $295.79 / $916.03
| Professional | | $295.79 | $295.79 | $916.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $291.41 / $291.41 / $291.41
| Facility | | $291.41 | $291.41 | $291.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $514.66 / $1,405.00 / $1,405.00
| Facility | | $514.66 | $1,405.00 | $1,405.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.47 / $177.47 / $1,478.95
| Professional | | $177.47 | $177.47 | $1,478.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.47 / $177.47 / $528.29
| Professional | | $177.47 | $177.47 | $528.29 |