- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $206.12 / $409.77 / $680.30
| Facility | | $206.12 | $409.77 | $680.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.12 / $225.36 / $233.61
| Professional | | $206.12 | $225.36 | $233.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,043.80 / $1,338.42 / $1,690.20
| Facility | | $1,043.80 | $1,338.42 | $1,690.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.90 / $228.90 / $348.91
| Professional | | $228.90 | $228.90 | $348.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.86 / $252.84 / $493.04
| Professional | | $219.86 | $252.84 | $493.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $178.64 / $605.57 / $1,407.36
| Facility | | $178.64 | $605.57 | $1,407.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $334.90 / $334.90 / $401.25
| Professional | | $334.90 | $334.90 | $401.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.83 / $329.80 / $406.75
| Professional | | $274.83 | $329.80 | $406.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.49 / $274.83 / $467.22
| Facility | | $218.49 | $274.83 | $467.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $377.00 / $544.16 / $659.59
| Professional | | $377.00 | $544.16 | $659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $192.38 / $305.01 / $510.25
| Facility | | $192.38 | $305.01 | $510.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.38 / $312.48 / $510.25
| Professional | | $192.38 | $312.48 | $510.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.43 / $142.91 / $357.28
| Professional | | $115.43 | $142.91 | $357.28 |