- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $164.32 / $398.24 / $963.20
| Facility | | $164.32 | $398.24 | $963.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.13 / $164.32 / $278.49
| Professional | | $110.13 | $164.32 | $278.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $183.55 / $279.70 / $722.21
| Facility | | $183.55 | $279.70 | $722.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.83 / $357.99 / $1,311.08
| Professional | | $160.83 | $357.99 | $1,311.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $176.06 / $371.60 / $454.91
| Facility | | $176.06 | $371.60 | $454.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.67 / $184.87 / $238.55
| Professional | | $83.67 | $184.87 | $238.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $167.03 / $235.68 / $541.38
| Facility | | $167.03 | $235.68 | $541.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.67 / $256.97 / $474.84
| Professional | | $172.67 | $256.97 | $474.84 |
- 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
- $174.81 / $174.81 / $262.22
| Facility | | $174.81 | $174.81 | $262.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $174.81 / $305.92 / $524.42
| Facility | | $174.81 | $305.92 | $524.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.33 / $218.51 / $263.95
| Professional | | $157.33 | $218.51 | $263.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $183.55 / $279.70 / $480.73
| Facility | | $183.55 | $279.70 | $480.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.34 / $340.09 / $406.35
| Professional | | $193.34 | $340.09 | $406.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.42 / $73.42 / $195.79
| Professional | | $73.42 | $73.42 | $195.79 |