- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $127.43 / $127.43 / $318.58
| Facility | | $127.43 | $127.43 | $318.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.22 / $103.22 / $127.43
| Professional | | $103.22 | $103.22 | $127.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.31 / $187.32 / $1,046.96
| Facility | | $123.31 | $187.32 | $1,046.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.97 / $50.97 / $143.97
| Professional | | $50.97 | $50.97 | $143.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $271.81 / $271.81 / $271.81
| Facility | | $271.81 | $271.81 | $271.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.70 / $128.97 / $134.59
| Professional | | $80.70 | $128.97 | $134.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.43 / $127.43 / $128.69
| Professional | | $127.43 | $127.43 | $128.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $127.43 / $127.43 / $318.58
| Facility | | $127.43 | $127.43 | $318.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.22 / $127.43 / $127.43
| Professional | | $103.22 | $127.43 | $127.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.45 / $91.02 / $227.55
| Professional | | $76.45 | $91.02 | $227.55 |