- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $239.88 / $1,905.46
| Facility | | $239.88 | $239.88 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $239.88 / $1,659.59
| Professional | | $190.55 | $239.88 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $229.09 / $977.24
| Facility | | $181.97 | $229.09 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $269.15 / $478.63
| Professional | | $269.15 | $269.15 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $758.58 / $1,023.29
| Facility | | $100.00 | $758.58 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $812.83 / $1,412.54
| Professional | | $416.87 | $812.83 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $288.40 / $288.40
| Facility | | $288.40 | $288.40 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $208.93 / $288.40
| Professional | | $208.93 | $208.93 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $288.40 / $537.03
| Professional | | $234.42 | $288.40 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $398.11 / $724.44
| Professional | | $263.03 | $398.11 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,089.30 / $2,089.30
| Facility | | $2,089.30 | $2,089.30 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $3,235.94 / $3,235.94
| Professional | | $2,238.72 | $3,235.94 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $446.68 / $446.68
| Professional | | $446.68 | $446.68 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $446.68 / $575.44
| Facility | | $128.82 | $446.68 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $208.93 / $426.58
| Professional | | $208.93 | $208.93 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $812.83 / $812.83
| Professional | | $812.83 | $812.83 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $346.74 / $398.11
| Professional | | $234.42 | $346.74 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.36 / $263.03 / $537.03
| Facility | | $32.36 | $263.03 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $239.88 / $436.52
| Professional | | $186.21 | $239.88 | $436.52 |