- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $144.54 / $144.54
| Facility | | $128.82 | $144.54 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $144.54 / $208.93
| Professional | | $112.20 | $144.54 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $741.31 / $2,137.96
| Facility | | $467.74 | $741.31 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $707.95 / $1,258.93 / $3,162.28
| Facility | 50 | $707.95 | $1,258.93 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $281.84 / $457.09
| Professional | | $190.55 | $281.84 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $288.40 / $416.87 / $660.69
| Professional | 50 | $288.40 | $416.87 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $501.19 / $1,202.26
| Facility | | $354.81 | $501.19 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $380.19 / $602.56
| Professional | | $229.09 | $380.19 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $478.63 / $954.99
| Facility | | $389.05 | $478.63 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $338.84 / $537.03
| Professional | | $245.47 | $338.84 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.03 / $223.87 / $398.11
| Facility | | $123.03 | $223.87 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $245.47 / $912.01
| Professional | | $131.83 | $245.47 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $346.74 / $346.74 / $346.74
| Professional | 50 | $346.74 | $346.74 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,862.09 / $3,715.35
| Facility | | $812.83 | $1,862.09 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $229.09 / $446.68
| Professional | | $134.90 | $229.09 | $446.68 |