- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.88 / $199.53 / $218.78
| Facility | | $154.88 | $199.53 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $107.15 / $154.88
| Professional | | $83.18 | $107.15 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $154.88 / $562.34
| Professional | | $100.00 | $154.88 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $331.13 / $524.81
| Facility | | $281.84 | $331.13 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $371.54 / $416.87
| Professional | | $158.49 | $371.54 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.82 / $1,380.38 / $1,905.46
| Facility | | $114.82 | $1,380.38 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $239.88 / $288.40
| Professional | | $208.93 | $239.88 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $95.50 / $154.88 / $1,023.29
| Facility | | $95.50 | $154.88 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $257.04 / $831.76
| Professional | | $114.82 | $257.04 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $169.82
| Professional | | $32.36 | $33.11 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $302.00 / $467.74
| Professional | | $169.82 | $302.00 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,230.27 / $1,230.27
| Facility | | $831.76 | $1,230.27 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $512.86 / $870.96
| Professional | | $147.91 | $512.86 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $269.15 / $269.15
| Professional | | $269.15 | $269.15 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $645.65 / $794.33
| Professional | | $309.03 | $645.65 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,071.52 / $1,412.54
| Facility | | $1,071.52 | $1,071.52 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $234.42 / $457.09
| Professional | | $109.65 | $234.42 | $457.09 |