- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $131.83 / $213.80
| Facility | | $104.71 | $131.83 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $154.88 / $323.59
| Professional | | $89.13 | $154.88 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.43 / $128.82 / $630.96
| Facility | | $79.43 | $128.82 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $154.88 / $389.05
| Professional | | $95.50 | $154.88 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $194.98 / $309.03
| Professional | | $112.20 | $194.98 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $154.88 / $288.40
| Professional | | $95.50 | $154.88 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $87.10 / $87.10 / $112.20
| Facility | | $87.10 | $87.10 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $186.21 / $263.03
| Professional | | $154.88 | $186.21 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $186.21 / $338.84
| Professional | | $102.33 | $186.21 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $199.53 / $234.42
| Professional | | $151.36 | $199.53 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.43 / $128.82 / $630.96
| Facility | | $79.43 | $128.82 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $154.88 / $398.11
| Professional | | $97.72 | $154.88 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $125.89 / $257.04
| Professional | | $102.33 | $125.89 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $104.71 / $104.71
| Facility | | $104.71 | $104.71 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $154.88 / $309.03
| Professional | | $93.33 | $154.88 | $309.03 |