- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $164.88 / $399.58 / $966.45
| Facility | | $164.88 | $399.58 | $966.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.50 / $164.88 / $259.58
| Professional | | $110.50 | $164.88 | $259.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $184.17 / $280.64 / $613.90
| Facility | | $184.17 | $280.64 | $613.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.88 / $359.41 / $1,315.50
| Professional | | $164.88 | $359.41 | $1,315.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $182.42 / $372.85 / $452.90
| Facility | | $182.42 | $372.85 | $452.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.59 / $190.83 / $256.58
| Professional | | $86.59 | $190.83 | $256.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $175.40 / $219.25 / $600.92
| Facility | | $175.40 | $219.25 | $600.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.40 / $298.18 / $543.08
| Professional | | $175.40 | $298.18 | $543.08 |
- 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
- $175.40 / $184.17 / $263.10
| Facility | | $175.40 | $184.17 | $263.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $175.40 / $306.95 / $526.20
| Facility | | $175.40 | $306.95 | $526.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.86 / $219.25 / $264.85
| Professional | | $157.86 | $219.25 | $264.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $184.17 / $280.82 / $482.35
| Facility | | $184.17 | $280.82 | $482.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.99 / $341.44 / $407.90
| Professional | | $193.99 | $341.44 | $407.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.67 / $73.67 / $196.45
| Professional | | $73.67 | $73.67 | $196.45 |