- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $247.66 / $843.78 / $1,897.08
| Facility | | $247.66 | $843.78 | $1,897.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.38 / $247.66 / $1,873.44
| Professional | | $189.38 | $247.66 | $1,873.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $260.00 / $581.26 / $1,436.40
| Facility | | $260.00 | $581.26 | $1,436.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.54 / $273.01 / $668.53
| Professional | | $116.54 | $273.01 | $668.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.00 / $439.95 / $801.24
| Facility | | $97.00 | $439.95 | $801.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.57 / $189.38 / $476.08
| Professional | | $132.57 | $189.38 | $476.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $198.05 / $488.60 / $975.31
| Facility | | $198.05 | $488.60 | $975.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.16 / $242.48 / $884.16
| Professional | | $154.16 | $242.48 | $884.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.08 / $291.36 / $393.34
| Professional | | $233.08 | $291.36 | $393.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.22 / $335.06 / $579.00
| Professional | | $262.22 | $335.06 | $579.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $506.97 / $1,383.96 / $1,383.96
| Facility | | $506.97 | $1,383.96 | $1,383.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,456.80 / $1,456.80 / $2,185.19
| Professional | | $1,456.80 | $1,456.80 | $2,185.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $233.09 / $349.63 / $835.73
| Facility | | $233.09 | $349.63 | $835.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.44 / $330.85 / $787.40
| Professional | | $156.44 | $330.85 | $787.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,022.67 / $1,022.67 / $1,022.67
| Professional | | $1,022.67 | $1,022.67 | $1,022.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.09 / $262.22 / $396.24
| Professional | | $233.09 | $262.22 | $396.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.37 / $122.37 / $578.87
| Professional | | $122.37 | $122.37 | $578.87 |