- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.96 / $398.11 / $1,258.93
| Facility | | $165.96 | $398.11 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $208.93 / $302.00
| Professional | | $162.18 | $208.93 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.43 / $79.43 / $79.43
| Facility | | $79.43 | $79.43 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $281.84 / $1,230.27
| Facility | | $177.83 | $281.84 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $331.13 / $398.11
| Professional | | $331.13 | $331.13 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,318.26 / $1,318.26
| Facility | | $1,318.26 | $1,318.26 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,041.74 / $2,041.74
| Professional | | $1,380.38 | $2,041.74 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $275.42 / $512.86
| Facility | | $208.93 | $275.42 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $218.78 / $331.13
| Professional | | $162.18 | $218.78 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $295.12 / $588.84
| Professional | | $275.42 | $295.12 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $275.42 / $758.58
| Facility | | $190.55 | $275.42 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $288.40 / $478.63
| Professional | | $79.43 | $288.40 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $114.82 / $275.42
| Facility | | $100.00 | $114.82 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $114.82 / $190.55
| Professional | | $114.82 | $114.82 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $275.42 / $281.84
| Professional | | $275.42 | $275.42 | $281.84 |