- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $101.19 / $139.50 / $227.50
| Facility | | $101.19 | $139.50 | $227.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.16 / $143.93 / $297.95
| Professional | | $79.16 | $143.93 | $297.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $87.18 / $458.76 / $458.76
| Facility | | $87.18 | $458.76 | $458.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.16 / $231.31 / $817.69
| Professional | | $113.16 | $231.31 | $817.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.37 / $200.23 / $306.73
| Professional | | $139.37 | $200.23 | $306.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.60 / $125.60 / $125.60
| Facility | | $125.60 | $125.60 | $125.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.61 / $175.13 / $298.12
| Professional | | $100.61 | $175.13 | $298.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $94.10 / $94.10 / $119.93
| Facility | | $94.10 | $94.10 | $119.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.02 / $179.88 / $211.62
| Professional | | $166.02 | $179.88 | $211.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.78 / $254.04 / $354.64
| Professional | | $135.78 | $254.04 | $354.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $397.86 / $397.86 / $397.86
| Facility | | $397.86 | $397.86 | $397.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.10 / $213.31 / $397.86
| Professional | | $149.10 | $213.31 | $397.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $458.76 / $458.76 / $458.76
| Facility | | $458.76 | $458.76 | $458.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.00 / $256.74 / $817.69
| Professional | | $130.00 | $256.74 | $817.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $63.04 / $76.05 / $114.62
| Facility | | $63.04 | $76.05 | $114.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.47 / $126.79 / $248.71
| Professional | | $76.47 | $126.79 | $248.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.19 / $179.70 / $335.18
| Professional | | $124.19 | $179.70 | $335.18 |