- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.35 / $367.85 / $646.49
| Facility | | $130.35 | $367.85 | $646.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.58 / $124.17 / $223.04
| Professional | | $105.58 | $124.17 | $223.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $118.90 / $183.64 / $436.67
| Facility | | $118.90 | $183.64 | $436.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.20 / $130.35 / $1,071.80
| Professional | | $78.20 | $130.35 | $1,071.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $256.06 / $366.17 / $640.15
| Facility | | $256.06 | $366.17 | $640.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.53 / $122.53 / $166.74
| Professional | | $122.53 | $122.53 | $166.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.60 / $222.80 / $503.22
| Facility | | $104.60 | $222.80 | $503.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.47 / $140.57 / $352.29
| Professional | | $78.47 | $140.57 | $352.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $3,472.00 / $9,239.00
| Facility | | $83.43 | $3,472.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.10 / $188.10 / $221.30
| Professional | | $188.10 | $188.10 | $221.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.35 / $130.35 / $423.86
| Professional | | $130.35 | $130.35 | $423.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $149.84 / $153.47 / $172.39
| Facility | | $149.84 | $153.47 | $172.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $273.43 / $622.71 / $622.71
| Facility | | $273.43 | $622.71 | $622.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.20 / $109.27 / $1,071.80
| Professional | | $78.20 | $109.27 | $1,071.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.20 / $109.27 / $250.40
| Professional | | $78.20 | $109.27 | $250.40 |