- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.83 / $363.08 / $691.83
| Facility | | $131.83 | $363.08 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $134.90 / $199.53
| Professional | | $114.82 | $134.90 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $173.78 / $691.83
| Facility | | $173.78 | $173.78 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $181.97 / $302.00
| Professional | | $181.97 | $181.97 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $141.25 / $158.49
| Professional | | $134.90 | $141.25 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $436.52 / $891.25
| Facility | | $177.83 | $436.52 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $213.80 / $257.04
| Professional | | $213.80 | $213.80 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $190.55 / $245.47
| Professional | | $173.78 | $190.55 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $194.98 / $288.40
| Facility | | $138.04 | $194.98 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $114.82 / $363.08
| Professional | | $114.82 | $114.82 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $67.61 / $173.78 / $338.84
| Facility | | $67.61 | $173.78 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $173.78 / $338.84
| Professional | | $67.61 | $173.78 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $173.78 / $208.93
| Facility | | $104.71 | $173.78 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $87.10 / $199.53
| Professional | | $74.13 | $87.10 | $199.53 |