- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.52 / $212.54 / $1,158.81
| Professional | | $135.52 | $212.54 | $1,158.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $188.22 / $188.22 / $188.22
| Facility | | $188.22 | $188.22 | $188.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.40 / $137.40 / $188.22
| Professional | | $137.40 | $137.40 | $188.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.02 / $637.76 / $831.82
| Professional | | $248.02 | $637.76 | $831.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $212.54 / $291.18 / $354.32
| Facility | | $212.54 | $291.18 | $354.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.45 / $333.06 / $372.04
| Professional | | $263.45 | $333.06 | $372.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.25 / $318.89 / $354.32
| Facility | | $281.25 | $318.89 | $354.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $301.22 / $318.89 / $354.32
| Professional | | $301.22 | $318.89 | $354.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.10 / $303.93 / $372.04
| Facility | | $181.10 | $303.93 | $372.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.40 / $310.26 / $389.75
| Professional | | $137.40 | $310.26 | $389.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.20 / $589.22 / $1,243.08
| Facility | | $295.20 | $589.22 | $1,243.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.72 / $389.75 / $389.75
| Professional | | $304.72 | $389.75 | $389.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.62 / $204.62 / $204.62
| Facility | | $204.62 | $204.62 | $204.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.46 / $150.28 / $286.70
| Professional | | $141.46 | $150.28 | $286.70 |