- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $89.13 / $630.96 / $812.83
| Facility | | $89.13 | $630.96 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $223.87 / $691.83
| Professional | | $70.79 | $223.87 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $776.25 / $1,318.26
| Facility | | $194.98 | $776.25 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $281.84 / $812.83
| Professional | | $169.82 | $281.84 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $562.34 / $794.33
| Facility | | $446.68 | $562.34 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $263.03 / $263.03
| Professional | | $263.03 | $263.03 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.20 / $218.78 / $549.54
| Facility | | $112.20 | $218.78 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $302.00 / $724.44
| Professional | | $165.96 | $302.00 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $407.38 / $478.63
| Professional | | $407.38 | $407.38 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $281.84 / $467.74
| Professional | | $281.84 | $281.84 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $776.25 / $1,318.26
| Facility | | $194.98 | $776.25 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $281.84 / $933.25
| Professional | | $169.82 | $281.84 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $169.82 / $281.84 / $338.84
| Facility | | $169.82 | $281.84 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $218.78 / $501.19
| Professional | | $169.82 | $218.78 | $501.19 |