- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.02 / $251.49 / $970.00
| Professional | | $171.02 | $251.49 | $970.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $244.07 / $244.07 / $244.07
| Facility | | $244.07 | $244.07 | $244.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.17 / $178.17 / $244.07
| Professional | | $178.17 | $178.17 | $244.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.44 / $712.34 / $929.07
| Professional | | $289.44 | $712.34 | $929.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.49 / $344.54 / $413.49
| Facility | | $251.49 | $344.54 | $413.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $307.45 / $388.68 / $434.16
| Professional | | $307.45 | $388.68 | $434.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $328.23 / $372.14 / $413.49
| Facility | | $328.23 | $372.14 | $413.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $352.05 / $413.49 / $413.49
| Professional | | $352.05 | $413.49 | $413.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $244.07 / $352.47 / $434.16
| Facility | | $244.07 | $352.47 | $434.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.17 / $362.07 / $454.84
| Professional | | $178.17 | $362.07 | $454.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $344.50 / $687.62 / $1,450.67
| Facility | | $344.50 | $687.62 | $1,450.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.60 / $454.84 / $454.84
| Professional | | $355.60 | $454.84 | $454.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.91 / $537.91 / $717.22
| Facility | | $537.91 | $537.91 | $717.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.25 / $167.72 / $321.47
| Professional | | $160.25 | $167.72 | $321.47 |