- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.90 / $483.91 / $1,330.20
| Facility | | $138.90 | $483.91 | $1,330.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.93 / $153.72 / $157.41
| Professional | | $100.93 | $153.72 | $157.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $244.00 / $614.00 / $927.85
| Facility | | $244.00 | $614.00 | $927.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.66 / $242.63 / $355.58
| Professional | | $144.66 | $242.63 | $355.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $59.40 / $244.46 / $1,661.24
| Facility | | $59.40 | $244.46 | $1,661.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.27 / $120.38 / $301.01
| Professional | | $84.27 | $120.38 | $301.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $122.19 / $310.58 / $619.96
| Facility | | $122.19 | $310.58 | $619.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.16 / $185.20 / $250.02
| Professional | | $148.16 | $185.20 | $250.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.68 / $212.98 / $393.93
| Professional | | $166.68 | $212.98 | $393.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $322.25 / $879.70 / $879.70
| Facility | | $322.25 | $879.70 | $879.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $922.30 / $922.30 / $1,389.00
| Professional | | $922.30 | $922.30 | $1,389.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $148.16 / $222.24 / $491.39
| Facility | | $148.16 | $222.24 | $491.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.20 / $203.72 / $277.80
| Professional | | $185.20 | $203.72 | $277.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.16 / $166.68 / $251.87
| Professional | | $148.16 | $166.68 | $251.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.78 / $78.52 / $371.70
| Professional | | $77.78 | $78.52 | $371.70 |