- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $1,318.26 / $1,862.09
| Facility | | $190.55 | $1,318.26 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $173.78 / $218.78
| Professional | | $114.82 | $173.78 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $707.95 / $851.14
| Facility | | $309.03 | $707.95 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $234.42 / $575.44
| Professional | | $151.36 | $234.42 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $229.09 / $316.23
| Professional | | $165.96 | $229.09 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $134.90 / $204.17
| Professional | | $134.90 | $134.90 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,047.13 / $1,513.56
| Facility | | $851.14 | $1,047.13 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $1,318.26 / $1,862.09
| Facility | | $190.55 | $1,318.26 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $173.78 / $257.04
| Professional | | $114.82 | $173.78 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $134.90 / $134.90
| Facility | | $134.90 | $134.90 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $134.90 / $134.90
| Professional | | $128.82 | $134.90 | $134.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $138.04 / $138.04
| Facility | | $128.82 | $138.04 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $128.82 / $416.87
| Professional | | $48.98 | $128.82 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $630.96 / $776.25
| Facility | | $323.59 | $630.96 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $158.49 / $269.15
| Professional | | $107.15 | $158.49 | $269.15 |