- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $126.08 / $489.04 / $879.89
| Facility | | $126.08 | $489.04 | $879.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.50 / $126.08 / $130.11
| Professional | | $84.50 | $126.08 | $130.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $140.84 / $214.61 / $554.14
| Facility | | $140.84 | $214.61 | $554.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.13 / $279.68 / $1,005.98
| Professional | | $134.13 | $279.68 | $1,005.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $139.49 / $285.10 / $346.32
| Facility | | $139.49 | $285.10 | $346.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.72 / $134.13 / $335.32
| Facility | | $120.72 | $134.13 | $335.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.72 / $134.13 / $335.32
| Professional | | $120.72 | $134.13 | $335.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.00 / $75.00 / $75.00
| Professional | | $75.00 | $75.00 | $75.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.72 / $147.54 / $234.73
| Facility | | $120.72 | $147.54 | $234.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.13 / $234.73 / $402.39
| Facility | | $134.13 | $234.73 | $402.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.72 / $167.66 / $202.54
| Professional | | $120.72 | $167.66 | $202.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $140.84 / $220.11 / $368.86
| Facility | | $140.84 | $220.11 | $368.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.35 / $262.14 / $328.68
| Professional | | $154.35 | $262.14 | $328.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.33 / $56.33 / $150.22
| Professional | | $56.33 | $56.33 | $150.22 |