- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $297.02 / $1,014.75 / $1,894.20
| Facility | | $297.02 | $1,014.75 | $1,894.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.93 / $282.88 / $681.74
| Professional | | $149.93 | $282.88 | $681.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.50 / $676.50 / $1,758.90
| Facility | | $676.50 | $676.50 | $1,758.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.15 / $113.15 / $881.45
| Professional | | $113.15 | $113.15 | $881.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $405.90 / $676.50 / $676.50
| Facility | | $405.90 | $676.50 | $676.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.50 / $676.50 / $676.50
| Professional | | $676.50 | $676.50 | $676.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $576.04 / $1,370.13 / $1,755.69
| Facility | | $576.04 | $1,370.13 | $1,755.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $405.82 / $1,218.85 / $3,260.73
| Professional | | $405.82 | $1,218.85 | $3,260.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.84 / $361.34 / $1,522.13
| Facility | | $225.84 | $361.34 | $1,522.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $473.55 / $705.79 / $1,238.00
| Professional | | $473.55 | $705.79 | $1,238.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.48 / $642.67 / $1,206.57
| Professional | | $309.48 | $642.67 | $1,206.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $254.50 / $1,429.12 / $1,755.69
| Facility | | $254.50 | $1,429.12 | $1,755.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.16 / $582.73 / $2,029.50
| Professional | | $212.16 | $582.73 | $2,029.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.81 / $169.73 / $444.08
| Professional | | $118.81 | $169.73 | $444.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $362.38 / $717.09 / $717.09
| Facility | | $362.38 | $717.09 | $717.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.38 / $676.50 / $796.24
| Professional | | $362.38 | $676.50 | $796.24 |