- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $191.72 / $436.98 / $769.52
| Facility | | $191.72 | $436.98 | $769.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.66 / $180.70 / $233.61
| Professional | | $145.66 | $180.70 | $233.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.93 / $109.93 / $614.29
| Professional | | $109.93 | $109.93 | $614.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $178.64 / $385.86 / $959.91
| Facility | | $178.64 | $385.86 | $959.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.94 / $401.25 / $1,324.68
| Professional | | $263.94 | $401.25 | $1,324.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $115.70 / $282.00 / $618.37
| Facility | | $115.70 | $282.00 | $618.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.38 / $357.28 / $596.38
| Professional | | $192.38 | $357.28 | $596.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.61 / $274.83 / $498.35
| Professional | | $233.61 | $274.83 | $498.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $178.64 / $555.00 / $989.80
| Facility | | $178.64 | $555.00 | $989.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.64 / $299.56 / $632.11
| Professional | | $178.64 | $299.56 | $632.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.43 / $164.90 / $431.44
| Professional | | $115.43 | $164.90 | $431.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $274.83 / $316.05 / $316.05
| Facility | | $274.83 | $316.05 | $316.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.61 / $274.83 / $330.32
| Professional | | $233.61 | $274.83 | $330.32 |