- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.35 / $130.35 / $325.88
| Facility | | $130.35 | $130.35 | $325.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.58 / $105.58 / $130.35
| Professional | | $105.58 | $105.58 | $130.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $126.14 / $191.61 / $1,361.63
| Facility | | $126.14 | $191.61 | $1,361.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.14 / $52.14 / $168.51
| Professional | | $52.14 | $52.14 | $168.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $278.04 / $278.04 / $278.04
| Facility | | $278.04 | $278.04 | $278.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.67 / $131.91 / $224.55
| Professional | | $91.67 | $131.91 | $224.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.35 / $130.35 / $131.65
| Professional | | $130.35 | $130.35 | $131.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.35 / $130.35 / $325.88
| Facility | | $130.35 | $130.35 | $325.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.58 / $130.35 / $130.35
| Professional | | $105.58 | $130.35 | $130.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.20 / $106.54 / $266.33
| Professional | | $78.20 | $106.54 | $266.33 |