- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $116.51 / $116.51 / $1,810.73
| Facility | | $116.51 | $116.51 | $1,810.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.52 / $122.75 / $184.59
| Professional | | $107.52 | $122.75 | $184.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $283.52 / $1,564.67 / $1,564.67
| Facility | | $283.52 | $1,564.67 | $1,564.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.67 / $208.22 / $1,165.68
| Professional | | $124.67 | $208.22 | $1,165.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.39 / $363.33 / $608.96
| Facility | | $300.39 | $363.33 | $608.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.79 / $229.18 / $301.29
| Professional | | $164.79 | $229.18 | $301.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $462.00 / $462.00 / $462.00
| Facility | | $462.00 | $462.00 | $462.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.56 / $183.31 / $344.84
| Professional | | $121.56 | $183.31 | $344.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.05 / $123.09 / $217.45
| Professional | | $66.05 | $123.09 | $217.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.68 / $278.77 / $370.30
| Professional | | $148.68 | $278.77 | $370.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $202.79 / $202.79 / $202.79
| Facility | | $202.79 | $202.79 | $202.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $283.52 / $1,564.67 / $1,564.67
| Facility | | $283.52 | $1,564.67 | $1,564.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.67 / $208.22 / $1,165.68
| Professional | | $124.67 | $208.22 | $1,165.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.94 / $213.66 / $245.42
| Facility | | $91.94 | $213.66 | $245.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.20 / $169.48 / $335.06
| Professional | | $114.20 | $169.48 | $335.06 |