- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $185.19 / $502.31 / $1,631.32
| Facility | | $185.19 | $502.31 | $1,631.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.57 / $185.19 / $209.88
| Professional | | $134.57 | $185.19 | $209.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $304.23 / $506.24 / $1,229.41
| Facility | | $304.23 | $506.24 | $1,229.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.77 / $48.97 / $150.86
| Professional | | $45.77 | $48.97 | $150.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $59.40 / $291.37 / $2,249.44
| Facility | | $59.40 | $291.37 | $2,249.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.35 / $160.50 / $293.63
| Professional | | $112.35 | $160.50 | $293.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $167.85 / $324.20 / $796.08
| Facility | | $167.85 | $324.20 | $796.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.73 / $301.08 / $376.35
| Professional | | $283.73 | $301.08 | $376.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.00 / $246.92 / $395.07
| Professional | | $99.00 | $246.92 | $395.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.54 / $246.92 / $432.11
| Professional | | $197.54 | $246.92 | $432.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $395.07 / $1,172.86 / $1,172.86
| Facility | | $395.07 | $1,172.86 | $1,172.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.00 / $20.00 / $20.00
| Professional | | $20.00 | $20.00 | $20.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.35 / $246.92 / $551.01
| Facility | | $162.35 | $246.92 | $551.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.13 / $234.57 / $271.61
| Professional | | $190.13 | $234.57 | $271.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.92 / $246.92 / $246.92
| Professional | | $246.92 | $246.92 | $246.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.71 / $103.71 / $377.79
| Professional | | $103.71 | $103.71 | $377.79 |