- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $758.58 / $758.58
| Facility | | $331.13 | $758.58 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $245.47 / $331.13
| Professional | | $204.17 | $245.47 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.70 / $63.10 / $812.83
| Professional | | $53.70 | $63.10 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $891.25 / $1,412.54
| Facility | | $758.58 | $891.25 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $691.83 / $851.14
| Professional | | $316.23 | $691.83 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,148.15 / $1,737.80
| Facility | | $302.00 | $1,148.15 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,659.59 / $1,819.70
| Professional | | $1,659.59 | $1,659.59 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $331.13 / $954.99
| Facility | | $245.47 | $331.13 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $165.96 / $1,380.38
| Professional | | $123.03 | $165.96 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $58.88 / $85.11
| Professional | | $50.12 | $58.88 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $645.65 / $912.01
| Professional | | $446.68 | $645.65 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $1,318.26 / $1,318.26
| Facility | | $549.54 | $1,318.26 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $1,096.48 / $1,380.38
| Professional | | $398.11 | $1,096.48 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $588.84 / $588.84
| Professional | | $588.84 | $588.84 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,513.56 / $2,089.30
| Professional | | $794.33 | $1,513.56 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $218.78 / $331.13
| Facility | | $218.78 | $218.78 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $165.96 / $457.09
| Professional | | $114.82 | $165.96 | $457.09 |