- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $266.51 / $2,241.94 / $4,019.13
| Facility | | $266.51 | $2,241.94 | $4,019.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.33 / $220.94 / $266.51
| Professional | | $169.33 | $220.94 | $266.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.23 / $269.23 / $269.23
| Professional | | $269.23 | $269.23 | $269.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $311.35 / $311.35 / $1,206.55
| Facility | | $311.35 | $311.35 | $1,206.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.86 / $321.57 / $690.59
| Professional | | $221.86 | $321.57 | $690.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.16 / $332.33 / $458.61
| Professional | | $245.16 | $332.33 | $458.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.10 / $2,283.34 / $2,811.84
| Facility | | $1,513.10 | $2,283.34 | $2,811.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.70 / $2,495.50 / $3,667.72
| Facility | | $338.70 | $2,495.50 | $3,667.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.75 / $228.78 / $293.37
| Professional | | $182.75 | $228.78 | $293.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.70 / $324.25 / $546.09
| Professional | | $207.70 | $324.25 | $546.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $311.35 / $311.35 / $1,005.46
| Facility | | $311.35 | $311.35 | $1,005.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.71 / $321.57 / $812.46
| Professional | | $222.71 | $321.57 | $812.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $207.29 / $207.29 / $220.00
| Facility | | $207.29 | $207.29 | $220.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.28 / $207.29 / $211.44
| Professional | | $195.28 | $207.29 | $211.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.82 / $236.96 / $394.87
| Professional | | $172.82 | $236.96 | $394.87 |