- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $352.74 / $854.86 / $2,067.63
| Facility | | $352.74 | $854.86 | $2,067.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.41 / $352.74 / $597.80
| Professional | | $236.41 | $352.74 | $597.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $394.01 / $600.40 / $1,550.31
| Facility | | $394.01 | $600.40 | $1,550.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $337.73 / $732.94 / $2,814.38
| Professional | | $337.73 | $732.94 | $2,814.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $390.26 / $831.98 / $1,012.81
| Facility | | $390.26 | $831.98 | $1,012.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.39 / $396.73 / $511.94
| Professional | | $179.39 | $396.73 | $511.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $358.23 / $505.44 / $1,160.72
| Facility | | $358.23 | $505.44 | $1,160.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $370.14 / $551.62 / $1,018.04
| Professional | | $370.14 | $551.62 | $1,018.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.00 / $75.00 / $75.00
| Professional | | $75.00 | $75.00 | $75.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.25 / $375.25 / $562.88
| Facility | | $375.25 | $375.25 | $562.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.25 / $656.69 / $1,125.75
| Facility | | $375.25 | $656.69 | $1,125.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $337.73 / $469.06 / $566.63
| Professional | | $337.73 | $469.06 | $566.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $394.01 / $600.40 / $1,031.94
| Facility | | $394.01 | $600.40 | $1,031.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $415.03 / $730.03 / $872.30
| Professional | | $415.03 | $730.03 | $872.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.61 / $157.61 / $420.28
| Professional | | $157.61 | $157.61 | $420.28 |