- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $124.08 / $324.47 / $909.33
| Facility | | $124.08 | $324.47 | $909.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.30 / $122.23 / $222.24
| Professional | | $96.30 | $122.23 | $222.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.00 / $75.00 / $111.12
| Professional | | $75.00 | $75.00 | $111.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.65 / $457.44 / $957.48
| Facility | | $229.65 | $457.44 | $957.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $101.86 / $259.27
| Professional | | $5.00 | $101.86 | $259.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.63 / $166.68 / $259.27
| Professional | | $129.63 | $166.68 | $259.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $183.35 / $183.35 / $185.20
| Facility | | $183.35 | $183.35 | $185.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.38 / $434.66 / $825.86
| Facility | | $120.38 | $434.66 | $825.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.07 / $107.06 / $291.48
| Professional | | $85.07 | $107.06 | $291.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $296.32 / $879.70 / $879.70
| Facility | | $296.32 | $879.70 | $879.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $922.30 / $922.30 / $1,389.00
| Professional | | $922.30 | $922.30 | $1,389.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.97 / $185.20 / $277.80
| Facility | | $112.97 | $185.20 | $277.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.20 / $185.20 / $231.50
| Professional | | $185.20 | $185.20 | $231.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.38 / $222.24 / $416.70
| Professional | | $120.38 | $222.24 | $416.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $124.02 / $190.68 / $666.79
| Facility | | $124.02 | $190.68 | $666.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.67 / $175.15 / $290.50
| Professional | | $87.67 | $175.15 | $290.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.67 / $77.78 / $185.20
| Facility | | $66.67 | $77.78 | $185.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.78 / $77.78 / $127.33
| Professional | | $77.78 | $77.78 | $127.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.23 / $185.20 / $250.02
| Professional | | $72.23 | $185.20 | $250.02 |