- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $191.70 / $800.73 / $1,866.01
| Facility | | $191.70 | $800.73 | $1,866.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.71 / $178.00 / $1,116.63
| Professional | | $128.71 | $178.00 | $1,116.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $178.05 / $353.68 / $870.04
| Facility | | $178.05 | $353.68 | $870.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.23 / $212.25 / $525.00
| Professional | | $94.23 | $212.25 | $525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $59.40 / $306.74 / $2,084.44
| Facility | | $59.40 | $306.74 | $2,084.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.09 / $147.27 / $450.64
| Professional | | $103.09 | $147.27 | $450.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $127.55 / $298.00 / $604.59
| Facility | | $127.55 | $298.00 | $604.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.65 / $179.52 / $854.82
| Professional | | $108.65 | $179.52 | $854.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.84 / $173.66 / $234.44
| Professional | | $147.84 | $173.66 | $234.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.29 / $199.71 / $393.55
| Professional | | $156.29 | $199.71 | $393.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.17 / $824.89 / $824.89
| Facility | | $302.17 | $824.89 | $824.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,302.45 / $1,367.63 / $1,367.63
| Professional | | $1,302.45 | $1,367.63 | $1,367.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.39 / $208.39 / $208.39
| Professional | | $208.39 | $208.39 | $208.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $168.45 / $277.86 / $526.02
| Facility | | $168.45 | $277.86 | $526.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.43 / $217.08 / $510.03
| Professional | | $122.43 | $217.08 | $510.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $609.54 / $609.54 / $609.54
| Professional | | $609.54 | $609.54 | $609.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.93 / $177.13 / $295.22
| Professional | | $138.93 | $177.13 | $295.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.20 / $142.93 / $537.70
| Professional | | $104.20 | $142.93 | $537.70 |