- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $145.69 / $938.03 / $2,545.56
| Facility | | $145.69 | $938.03 | $2,545.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.69 / $145.69 / $1,419.36
| Professional | | $145.69 | $145.69 | $1,419.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $337.80 / $444.30 / $859.42
| Facility | | $337.80 | $444.30 | $859.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.74 / $350.98 / $362.00
| Professional | | $318.74 | $350.98 | $362.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $400.82 / $449.74 / $565.09
| Professional | | $400.82 | $449.74 | $565.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $132.44 / $673.57 / $1,048.52
| Facility | | $132.44 | $673.57 | $1,048.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.44 / $132.44 / $870.32
| Professional | | $132.44 | $132.44 | $870.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $264.89 / $454.72 / $619.04
| Facility | | $264.89 | $454.72 | $619.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.89 / $454.72 / $619.04
| Professional | | $264.89 | $454.72 | $619.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.27 / $375.26 / $450.31
| Professional | | $258.27 | $375.26 | $450.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.82 / $132.44 / $441.48
| Professional | | $125.82 | $132.44 | $441.48 |