- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $389.05 / $1,000.00
| Facility | | $251.19 | $389.05 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $147.91 / $1,122.02
| Professional | | $112.20 | $147.91 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $380.19 / $851.14
| Facility | | $338.84 | $380.19 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $263.03 / $281.84
| Professional | | $245.47 | $263.03 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $151.36 / $151.36
| Facility | | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $323.59 / $407.38
| Professional | | $186.21 | $323.59 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.33 / $213.80 / $812.83
| Facility | | $102.33 | $213.80 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $102.33 / $371.54
| Professional | | $70.79 | $102.33 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $436.52 / $436.52
| Professional | | $346.74 | $436.52 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $436.52 / $436.52
| Professional | | $436.52 | $436.52 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $70.79 / $162.18 / $338.84
| Facility | | $70.79 | $162.18 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $102.33 / $169.82
| Professional | | $77.62 | $102.33 | $169.82 |