- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.01 / $302.42 / $520.15
| Professional | | $212.01 | $302.42 | $520.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.61 / $37.25 / $868.13
| Facility | | $33.61 | $37.25 | $868.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $372.48 / $488.50 / $601.11
| Professional | | $372.48 | $488.50 | $601.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $819.45 / $819.45 / $819.45
| Facility | | $819.45 | $819.45 | $819.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $295.62 / $549.86
| Professional | | $100.00 | $295.62 | $549.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.55 / $354.55 / $549.86
| Facility | | $354.55 | $354.55 | $549.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $301.37 / $354.55 / $617.63
| Professional | | $301.37 | $354.55 | $617.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $519.21 / $519.21 / $623.04
| Professional | | $519.21 | $519.21 | $623.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $382.72 / $446.51 / $801.00
| Professional | | $382.72 | $446.51 | $801.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $665.84 / $2,544.80 / $2,544.80
| Facility | | $665.84 | $2,544.80 | $2,544.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $219.85 / $371.69 / $692.15
| Facility | | $219.85 | $371.69 | $692.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $301.37 / $354.55 / $427.32
| Professional | | $301.37 | $354.55 | $427.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,032.39 / $1,032.39 / $1,032.39
| Professional | | $1,032.39 | $1,032.39 | $1,032.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.02 / $407.02 / $519.21
| Professional | | $407.02 | $407.02 | $519.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.38 / $272.36 / $467.53
| Professional | | $262.38 | $272.36 | $467.53 |