- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $233.61 / $795.91 / $1,789.45
| Facility | | $233.61 | $795.91 | $1,789.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.64 / $233.61 / $1,767.16
| Professional | | $178.64 | $233.61 | $1,767.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $255.98 / $550.02 / $1,354.91
| Facility | | $255.98 | $550.02 | $1,354.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.93 / $257.52 / $630.61
| Professional | | $109.93 | $257.52 | $630.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.00 / $414.99 / $755.78
| Facility | | $97.00 | $414.99 | $755.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.05 / $178.64 / $449.08
| Professional | | $125.05 | $178.64 | $449.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.81 / $460.89 / $920.00
| Facility | | $186.81 | $460.89 | $920.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.57 / $228.75 / $834.92
| Professional | | $145.57 | $228.75 | $834.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.86 / $274.83 / $371.02
| Professional | | $219.86 | $274.83 | $371.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $247.35 / $316.05 / $599.13
| Professional | | $247.35 | $316.05 | $599.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.20 / $1,305.44 / $1,305.44
| Facility | | $478.20 | $1,305.44 | $1,305.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,374.15 / $1,374.15 / $2,061.23
| Professional | | $1,374.15 | $1,374.15 | $2,061.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $219.86 / $329.80 / $788.34
| Facility | | $219.86 | $329.80 | $788.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.72 / $316.05 / $743.55
| Professional | | $147.72 | $316.05 | $743.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $964.65 / $964.65 / $964.65
| Professional | | $964.65 | $964.65 | $964.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.86 / $247.35 / $373.76
| Professional | | $219.86 | $247.35 | $373.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.43 / $115.43 / $546.03
| Professional | | $115.43 | $115.43 | $546.03 |