- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $602.56 / $602.56
| Facility | | $128.82 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $104.71 / $169.82
| Professional | | $87.10 | $104.71 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $218.78 / $389.05
| Facility | | $218.78 | $218.78 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $107.15 / $107.15
| Professional | | $107.15 | $107.15 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $288.40 / $354.81
| Professional | | $134.90 | $288.40 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $134.90 / $134.90
| Facility | | $134.90 | $134.90 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $147.91 / $186.21
| Professional | | $114.82 | $147.91 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.23 / $147.91 / $208.93
| Facility | | $120.23 | $147.91 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.23 / $186.21 / $354.81
| Facility | | $120.23 | $186.21 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $147.91 / $186.21
| Professional | | $79.43 | $147.91 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $398.11 / $524.81
| Facility | | $234.42 | $398.11 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $114.82 / $162.18
| Professional | | $107.15 | $114.82 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $162.18 / $213.80
| Facility | | $162.18 | $162.18 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $56.23 / $162.18
| Professional | | $56.23 | $56.23 | $162.18 |