- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $170.93 / $170.94 / $2,689.55
| Facility | | $170.93 | $170.94 | $2,689.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.50 / $148.66 / $170.94
| Professional | | $84.50 | $148.66 | $170.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $216.50 / $216.50 / $706.57
| Facility | | $216.50 | $216.50 | $706.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.61 / $204.15 / $410.44
| Professional | | $141.61 | $204.15 | $410.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.11 / $176.38 / $242.00
| Professional | | $130.11 | $176.38 | $242.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.02 / $1,177.18 / $1,797.76
| Facility | | $524.02 | $1,177.18 | $1,797.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.41 / $183.41 / $195.45
| Professional | | $183.41 | $183.41 | $195.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $170.93 / $532.27 / $3,174.46
| Facility | | $170.93 | $532.27 | $3,174.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.25 / $149.86 / $187.06
| Professional | | $92.25 | $149.86 | $187.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.70 / $1,304.25 / $2,198.26
| Professional | | $103.70 | $1,304.25 | $2,198.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $216.50 / $216.50 / $588.80
| Facility | | $216.50 | $216.50 | $588.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.22 / $204.15 / $432.57
| Professional | | $142.22 | $204.15 | $432.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $103.65 / $103.65 / $110.00
| Facility | | $103.65 | $103.65 | $110.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.12 / $103.65 / $105.72
| Professional | | $79.12 | $103.65 | $105.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.00 / $120.00 / $212.28
| Professional | | $85.00 | $120.00 | $212.28 |