- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $122.86 / $126.65 / $526.60
| Facility | | $122.86 | $126.65 | $526.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.65 / $152.63 / $262.00
| Professional | | $126.65 | $152.63 | $262.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $259.35 / $846.00 / $1,382.94
| Facility | | $259.35 | $846.00 | $1,382.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.18 / $215.33 / $283.07
| Professional | | $120.18 | $215.33 | $283.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.50 / $374.31 / $482.04
| Facility | | $316.50 | $374.31 | $482.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.80 / $208.80 / $223.46
| Professional | | $208.80 | $208.80 | $223.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $175.00 / $175.00 / $175.00
| Facility | | $175.00 | $175.00 | $175.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.75 / $175.00 / $344.25
| Professional | | $127.75 | $175.00 | $344.25 |
- 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
- $234.69 / $234.69 / $246.42
| Professional | | $234.69 | $234.69 | $246.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $356.08 / $356.08 / $368.93
| Facility | | $356.08 | $356.08 | $368.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.27 / $220.69 / $220.69
| Professional | | $174.27 | $220.69 | $220.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.83 / $1,382.94 / $1,382.94
| Facility | | $602.83 | $1,382.94 | $1,382.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.30 / $144.61 / $283.07
| Professional | | $110.30 | $144.61 | $283.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $353.74 / $353.74 / $353.74
| Facility | | $353.74 | $353.74 | $353.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.18 / $154.94 / $283.07
| Professional | | $112.18 | $154.94 | $283.07 |