- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.66 / $440.24 / $1,064.81
| Facility | | $181.66 | $440.24 | $1,064.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.75 / $181.66 / $286.01
| Professional | | $121.75 | $181.66 | $286.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $202.91 / $309.20 / $676.38
| Facility | | $202.91 | $309.20 | $676.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.52 / $395.57 / $1,449.38
| Professional | | $190.52 | $395.57 | $1,449.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $200.98 / $410.78 / $498.99
| Facility | | $200.98 | $410.78 | $498.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.37 / $210.18 / $282.58
| Professional | | $95.37 | $210.18 | $282.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $193.25 / $241.56 / $661.87
| Facility | | $193.25 | $241.56 | $661.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.25 / $328.52 / $598.15
| Professional | | $193.25 | $328.52 | $598.15 |
- 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
- $193.25 / $202.91 / $289.88
| Facility | | $193.25 | $202.91 | $289.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $193.25 / $338.19 / $579.75
| Facility | | $193.25 | $338.19 | $579.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.93 / $241.56 / $291.81
| Professional | | $173.93 | $241.56 | $291.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $202.91 / $309.30 / $531.44
| Facility | | $202.91 | $309.30 | $531.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.73 / $375.79 / $449.69
| Professional | | $213.73 | $375.79 | $449.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.17 / $81.17 / $216.44
| Professional | | $81.17 | $81.17 | $216.44 |