- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $136.04 / $235.03 / $9,673.40
| Facility | | $136.04 | $235.03 | $9,673.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.33 / $107.40 / $2,969.16
| Professional | | $106.33 | $107.40 | $2,969.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.04 / $163.25 / $338.65
| Professional | | $136.04 | $163.25 | $338.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.32 / $120.38 / $120.38
| Facility | | $102.32 | $120.38 | $120.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.89 / $130.41 / $166.84
| Professional | | $123.89 | $130.41 | $166.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.33 / $196.32 / $340.11
| Professional | | $106.33 | $196.32 | $340.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $122.10 / $210.86 / $273.50
| Facility | | $122.10 | $210.86 | $273.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.04 / $161.88 / $417.50
| Professional | | $136.04 | $161.88 | $417.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $163.25 / $196.32 / $271.10
| Facility | | $163.25 | $196.32 | $271.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.25 / $196.32 / $431.05
| Professional | | $163.25 | $196.32 | $431.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.41 / $191.50 / $330.46
| Professional | | $124.41 | $191.50 | $330.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.33 / $106.33 / $126.53
| Professional | | $106.33 | $106.33 | $126.53 |