- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $258.33 / $646.82 / $1,514.31
| Facility | | $258.33 | $646.82 | $1,514.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.14 / $258.33 / $437.83
| Professional | | $173.14 | $258.33 | $437.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.57 / $439.73 / $1,135.43
| Facility | | $288.57 | $439.73 | $1,135.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.00 / $562.87 / $2,061.23
| Professional | | $270.00 | $562.87 | $2,061.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $146.16 / $446.60 / $709.65
| Facility | | $146.16 | $446.60 | $709.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.25 / $315.99 / $374.80
| Professional | | $282.25 | $315.99 | $374.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $274.83 / $343.54 / $940.31
| Facility | | $274.83 | $343.54 | $940.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.83 / $467.21 / $849.78
| Professional | | $274.83 | $467.21 | $849.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.00 / $75.00 / $75.00
| Professional | | $75.00 | $75.00 | $75.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $274.83 / $274.83 / $412.25
| Facility | | $274.83 | $274.83 | $412.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $274.83 / $480.95 / $824.49
| Facility | | $274.83 | $480.95 | $824.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $247.35 / $343.54 / $414.99
| Professional | | $247.35 | $343.54 | $414.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.57 / $439.73 / $755.78
| Facility | | $288.57 | $439.73 | $755.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $303.95 / $534.73 / $639.32
| Professional | | $303.95 | $534.73 | $639.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.43 / $115.43 / $307.81
| Professional | | $115.43 | $115.43 | $307.81 |