- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $257.04 / $371.54
| Facility | | $257.04 | $257.04 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $117.49 / $275.42
| Professional | | $77.62 | $117.49 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $288.40 / $512.86
| Facility | | $141.25 | $288.40 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $144.54 / $144.54
| Professional | | $141.25 | $144.54 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.20 / $295.12 / $562.34
| Facility | | $112.20 | $295.12 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $107.15 / $245.47
| Professional | | $61.66 | $107.15 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $144.54 / $213.80
| Facility | | $141.25 | $144.54 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $151.36 / $177.83
| Professional | | $134.90 | $151.36 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $104.71 / $123.03
| Professional | | $104.71 | $104.71 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $288.40 / $512.86
| Facility | | $213.80 | $288.40 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $120.23 / $151.36
| Professional | | $120.23 | $120.23 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $141.25 / $141.25
| Professional | | $141.25 | $141.25 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $60.26 / $141.25
| Professional | | $60.26 | $60.26 | $141.25 |