- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $562.34 / $776.25
| Facility | | $173.78 | $562.34 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $194.98 / $234.42
| Professional | | $165.96 | $194.98 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,174.90 / $1,174.90
| Facility | | $1,174.90 | $1,174.90 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $147.91 / $1,230.27
| Professional | | $147.91 | $147.91 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,511.89 / $3,630.78
| Facility | | $2,041.74 | $2,511.89 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $234.42 / $245.47
| Professional | | $234.42 | $234.42 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $194.98 / $398.11
| Facility | | $177.83 | $194.98 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $302.00 / $363.08
| Professional | | $302.00 | $302.00 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $354.81 / $426.58
| Professional | | $354.81 | $354.81 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $251.19 / $398.11
| Professional | | $251.19 | $251.19 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,174.90 / $1,174.90
| Facility | | $1,174.90 | $1,174.90 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $147.91 / $1,230.27
| Professional | | $147.91 | $147.91 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.91 / $251.19 / $295.12
| Facility | | $147.91 | $251.19 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $190.55 / $436.52
| Professional | | $147.91 | $190.55 | $436.52 |