- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $182.09 / $873.63 / $1,619.80
| Facility | | $182.09 | $873.63 | $1,619.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.98 / $182.09 / $182.09
| Professional | | $108.98 | $182.09 | $182.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $222.77 / $385.20 / $1,172.86
| Facility | | $222.77 | $385.20 | $1,172.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.77 / $185.19 / $378.72
| Professional | | $45.77 | $185.19 | $378.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $201.46 / $401.25 / $500.18
| Facility | | $201.46 | $401.25 | $500.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.73 / $283.73 / $354.66
| Professional | | $283.73 | $283.73 | $354.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $222.23 / $271.61 / $432.11
| Facility | | $222.23 | $271.61 | $432.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $193.71 / $290.57 / $532.70
| Facility | | $193.71 | $290.57 | $532.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.34 / $203.40 / $275.07
| Professional | | $174.34 | $203.40 | $275.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $259.27 / $395.07 / $679.03
| Facility | | $259.27 | $395.07 | $679.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.19 / $246.92 / $666.46
| Professional | | $185.19 | $246.92 | $666.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.36 / $81.36 / $216.96
| Professional | | $81.36 | $81.36 | $216.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.11 / $111.11 / $127.90
| Professional | | $111.11 | $111.11 | $127.90 |