- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $256.14 / $1,039.82 / $1,260.33
| Facility | | $256.14 | $1,039.82 | $1,260.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.81 / $244.09 / $256.14
| Professional | | $180.81 | $244.09 | $256.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.05 / $235.05 / $235.05
| Professional | | $235.05 | $235.05 | $235.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $285.98 / $412.77 / $999.68
| Facility | | $285.98 | $412.77 | $999.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,452.51 / $1,452.51 / $1,452.51
| Professional | | $1,452.51 | $1,452.51 | $1,452.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.42 / $406.82 / $744.33
| Professional | | $316.42 | $406.82 | $744.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $310.39 / $855.54 / $1,244.58
| Facility | | $310.39 | $855.54 | $1,244.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.78 / $256.14 / $1,244.58
| Professional | | $197.78 | $256.14 | $1,244.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.00 / $452.02 / $602.70
| Professional | | $446.00 | $452.02 | $602.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $293.44 / $466.65 / $999.68
| Facility | | $293.44 | $466.65 | $999.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,452.51 / $1,452.51 / $1,452.51
| Professional | | $1,452.51 | $1,452.51 | $1,452.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $301.35 / $301.35 / $331.49
| Facility | | $301.35 | $301.35 | $331.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $301.35 / $301.35 / $331.49
| Professional | | $301.35 | $301.35 | $331.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $126.57 / $126.57 / $126.57
| Facility | | $126.57 | $126.57 | $126.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.57 / $180.81 / $421.89
| Professional | | $126.57 | $180.81 | $421.89 |