- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.51 / $480.40 / $1,254.18
| Facility | | $190.51 | $480.40 | $1,254.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.16 / $190.51 / $308.94
| Professional | | $144.16 | $190.51 | $308.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $280.62 / $792.95 / $1,431.42
| Facility | | $280.62 | $792.95 | $1,431.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $141.60 / $360.43
| Professional | | $5.00 | $141.60 | $360.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.45 / $386.18 / $1,028.73
| Facility | | $257.45 | $386.18 | $1,028.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $257.45 / $257.45
| Facility | | $80.00 | $257.45 | $257.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $221.24 / $596.11 / $1,301.00
| Facility | | $221.24 | $596.11 | $1,301.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.96 / $197.95 / $531.91
| Professional | | $145.96 | $197.95 | $531.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $447.96 / $1,222.89 / $1,222.89
| Facility | | $447.96 | $1,222.89 | $1,222.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,319.21 / $1,358.79 / $1,930.88
| Professional | | $1,319.21 | $1,358.79 | $1,930.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.19 / $257.45 / $400.48
| Facility | | $162.19 | $257.45 | $400.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.58 / $257.45 / $321.81
| Professional | | $244.58 | $257.45 | $321.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.19 / $321.81 / $579.26
| Professional | | $283.19 | $321.81 | $579.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.51 / $302.37 / $1,089.57
| Facility | | $190.51 | $302.37 | $1,089.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.08 / $248.76 / $500.59
| Professional | | $149.08 | $248.76 | $500.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.13 / $148.63 / $203.25
| Professional | | $108.13 | $148.63 | $203.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.14 / $133.36 / $257.45
| Professional | | $127.14 | $133.36 | $257.45 |