- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $1,023.29 / $1,659.59
| Facility | | $346.74 | $1,023.29 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $204.17 / $245.47
| Professional | | $162.18 | $204.17 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $616.60 / $1,258.93
| Facility | | $323.59 | $616.60 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.62 / $40.74 / $213.80
| Professional | | $31.62 | $40.74 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $69.18 / $575.44 / $2,398.83
| Facility | | $69.18 | $575.44 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $194.98 / $575.44
| Professional | | $144.54 | $194.98 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.96 / $398.11 / $831.76
| Facility | | $165.96 | $398.11 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $302.00 / $2,137.96
| Professional | | $131.83 | $302.00 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $245.47 / $269.15
| Professional | | $199.53 | $245.47 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $245.47 / $436.52
| Professional | | $199.53 | $245.47 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,174.90 / $1,174.90
| Facility | | $1,174.90 | $1,174.90 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.95 / $19.95 / $19.95
| Professional | | $19.95 | $19.95 | $19.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.96 / $281.84 / $630.96
| Facility | | $165.96 | $281.84 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.18 / $245.47 / $2,691.53
| Professional | | $28.18 | $245.47 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $245.47 / $245.47
| Professional | | $245.47 | $245.47 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $223.87 / $338.84
| Professional | | $199.53 | $223.87 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $134.90 / $245.47
| Facility | | $104.71 | $134.90 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $109.65 / $436.52
| Professional | | $104.71 | $109.65 | $436.52 |