- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $172.21 / $443.61 / $19,197.36
| Facility | | $172.21 | $443.61 | $19,197.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.22 / $173.94 / $338.66
| Professional | | $172.22 | $173.94 | $338.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.81 / $186.84 / $8,639.91
| Facility | | $158.81 | $186.84 | $8,639.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.72 / $178.72 / $178.72
| Professional | | $178.72 | $178.72 | $178.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.47 / $172.22 / $172.22
| Facility | | $162.47 | $172.22 | $172.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.22 / $172.22 / $172.22
| Professional | | $172.22 | $172.22 | $172.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $442.70 / $442.70 / $652.77
| Facility | | $442.70 | $442.70 | $652.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.66 / $421.99 / $12,465.51
| Facility | | $173.66 | $421.99 | $12,465.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.22 / $173.94 / $522.70
| Professional | | $172.22 | $173.94 | $522.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.47 / $172.22 / $172.22
| Facility | | $162.47 | $172.22 | $172.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.22 / $172.22 / $172.22
| Professional | | $172.22 | $172.22 | $172.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $143.65 / $143.65 / $166.69
| Facility | | $143.65 | $143.65 | $166.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.65 / $143.65 / $166.69
| Professional | | $143.65 | $143.65 | $166.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.22 / $172.22 / $243.23
| Professional | | $172.22 | $172.22 | $243.23 |