- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.78 / $399.08 / $1,159.54
| Facility | | $162.78 | $399.08 | $1,159.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.01 / $164.97 / $337.68
| Professional | | $134.01 | $164.97 | $337.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.83 / $303.05 / $826.74
| Facility | | $181.83 | $303.05 | $826.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.78 / $359.84 / $1,423.97
| Professional | | $162.78 | $359.84 | $1,423.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $119.88 / $354.56 / $555.88
| Facility | | $119.88 | $354.56 | $555.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.09 / $194.57 / $254.57
| Professional | | $108.09 | $194.57 | $254.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.17 / $255.06 / $536.62
| Facility | | $173.17 | $255.06 | $536.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.17 / $339.84 / $541.94
| Professional | | $173.17 | $339.84 | $541.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.12 / $169.53 / $466.09
| Professional | | $154.12 | $169.53 | $466.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.17 / $173.17 / $363.66
| Facility | | $173.17 | $173.17 | $363.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.17 / $303.05 / $519.51
| Facility | | $173.17 | $303.05 | $519.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.85 / $155.85 / $155.85
| Professional | | $155.85 | $155.85 | $155.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.83 / $285.73 / $476.22
| Facility | | $181.83 | $285.73 | $476.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.92 / $336.73 / $402.48
| Professional | | $201.92 | $336.73 | $402.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.90 / $141.76 / $261.51
| Professional | | $103.90 | $141.76 | $261.51 |