- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.47 / $190.47 / $190.47
| Facility | | $190.47 | $190.47 | $190.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.43 / $194.48 / $377.80
| Professional | | $164.43 | $194.48 | $377.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.90 / $190.27 / $245.45
| Professional | | $173.90 | $190.27 | $245.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.17 / $209.80 / $331.64
| Professional | | $202.17 | $209.80 | $331.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $228.74 / $228.74 / $228.74
| Facility | | $228.74 | $228.74 | $228.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.21 / $220.86 / $375.01
| Professional | | $171.21 | $220.86 | $375.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $444.55 / $444.55 / $444.55
| Facility | | $444.55 | $444.55 | $444.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.58 / $277.02 / $414.58
| Professional | | $209.58 | $277.02 | $414.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.39 / $241.04 / $327.30
| Professional | | $226.39 | $241.04 | $327.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.28 / $216.79 / $458.34
| Professional | | $166.28 | $216.79 | $458.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $185.10 / $185.10 / $185.10
| Facility | | $185.10 | $185.10 | $185.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.10 / $323.39 / $408.30
| Professional | | $185.10 | $323.39 | $408.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $228.74 / $228.74 / $228.74
| Facility | | $228.74 | $228.74 | $228.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.21 / $219.87 / $372.93
| Professional | | $171.21 | $219.87 | $372.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $196.34 / $196.34 / $196.34
| Facility | | $196.34 | $196.34 | $196.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.72 / $196.34 / $227.78
| Professional | | $191.72 | $196.34 | $227.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.84 / $193.06 / $319.39
| Professional | | $152.84 | $193.06 | $319.39 |