- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $416.87 / $575.44
| Facility | | $128.82 | $416.87 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $151.36 / $457.09
| Professional | | $123.03 | $151.36 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $213.80 / $645.65
| Facility | | $138.04 | $213.80 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $186.21 / $691.83
| Professional | | $112.20 | $186.21 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $229.09 / $371.54
| Facility | | $186.21 | $229.09 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $173.78 / $173.78
| Professional | | $173.78 | $173.78 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.83 / $144.54 / $295.12
| Facility | | $131.83 | $144.54 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $223.87 / $457.09
| Professional | | $100.00 | $223.87 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $3,630.78 / $9,772.37
| Facility | | $83.18 | $3,630.78 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $269.15 / $316.23
| Professional | | $269.15 | $269.15 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $186.21 / $389.05
| Professional | | $186.21 | $186.21 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $213.80 / $645.65
| Facility | | $138.04 | $213.80 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $186.21 / $691.83
| Professional | | $112.20 | $186.21 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.20 / $186.21 / $223.87
| Facility | | $112.20 | $186.21 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $186.21 / $354.81
| Professional | | $112.20 | $186.21 | $354.81 |