- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $113.10 / $212.42 / $212.42
| Facility | | $113.10 | $212.42 | $212.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.42 / $246.52 / $425.71
| Professional | | $212.42 | $246.52 | $425.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $332.51 / $1,011.08 / $2,319.50
| Facility | | $332.51 | $1,011.08 | $2,319.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.99 / $352.07 / $474.78
| Professional | | $218.99 | $352.07 | $474.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $530.83 / $627.79 / $808.47
| Facility | | $530.83 | $627.79 | $808.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $364.98 / $364.98 / $374.79
| Professional | | $364.98 | $364.98 | $374.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $278.04 / $278.04 / $278.04
| Facility | | $278.04 | $278.04 | $278.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.97 / $278.04 / $577.50
| Professional | | $202.97 | $278.04 | $577.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $393.63 / $393.63 / $413.31
| Professional | | $393.63 | $393.63 | $413.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $370.16 / $370.16 / $370.16
| Professional | | $370.16 | $370.16 | $370.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,011.08 / $2,319.50 / $2,319.50
| Facility | | $1,011.08 | $2,319.50 | $2,319.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.91 / $258.99 / $474.78
| Professional | | $189.91 | $258.99 | $474.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.35 / $220.01 / $290.45
| Facility | | $0.35 | $220.01 | $290.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.63 / $271.04 / $486.17
| Professional | | $200.63 | $271.04 | $486.17 |