- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $176.25 / $179.71 / $183.16
| Facility | | $176.25 | $179.71 | $183.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.99 / $183.16 / $290.07
| Professional | | $166.99 | $183.16 | $290.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.00 / $235.00 / $235.00
| Professional | | $235.00 | $235.00 | $235.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $394.68 / $394.68 / $394.68
| Facility | | $394.68 | $394.68 | $394.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.27 / $218.27 / $218.27
| Facility | | $218.27 | $218.27 | $218.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.34 / $159.34 / $218.27
| Professional | | $159.34 | $159.34 | $218.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $684.92 / $1,743.72 / $1,743.72
| Facility | | $684.92 | $1,743.72 | $1,743.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,159.38 / $2,159.38 / $3,374.03
| Professional | | $2,159.38 | $2,159.38 | $3,374.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.67 / $263.70 / $394.68
| Facility | | $108.67 | $263.70 | $394.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.67 / $355.21 / $394.68
| Professional | | $108.67 | $355.21 | $394.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $394.68 / $434.15 / $888.03
| Professional | | $394.68 | $434.15 | $888.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.67 / $263.70 / $394.68
| Facility | | $108.67 | $263.70 | $394.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.34 / $159.34 / $224.82
| Professional | | $159.34 | $159.34 | $224.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.27 / $202.85 / $241.49
| Professional | | $140.27 | $202.85 | $241.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.21 / $205.57 / $394.68
| Professional | | $202.21 | $205.57 | $394.68 |