- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $115.73 / $283.20 / $478.63
| Facility | | $115.73 | $283.20 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.21 / $320.00 / $760.33
| Professional | | $181.21 | $320.00 | $760.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.44 / $346.40 / $8,639.91
| Facility | | $294.44 | $346.40 | $8,639.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.08 / $329.08 / $329.08
| Professional | | $329.08 | $329.08 | $329.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.87 / $323.87 / $323.87
| Facility | | $323.87 | $323.87 | $323.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.87 / $323.87 / $323.87
| Professional | | $323.87 | $323.87 | $323.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.74 / $338.74 / $483.91
| Facility | | $338.74 | $338.74 | $483.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $119.93 / $283.20 / $478.63
| Facility | | $119.93 | $283.20 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.00 / $309.29 / $752.00
| Professional | | $179.00 | $309.29 | $752.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.87 / $323.87 / $323.87
| Facility | | $323.87 | $323.87 | $323.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.87 / $323.87 / $323.87
| Professional | | $323.87 | $323.87 | $323.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $267.10 / $267.10 / $267.10
| Facility | | $267.10 | $267.10 | $267.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.10 / $267.10 / $267.10
| Professional | | $267.10 | $267.10 | $267.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.17 / $346.40 / $433.00
| Professional | | $289.17 | $346.40 | $433.00 |