- 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
- $93.33 / $177.83 / $398.11
| Professional | | $93.33 | $177.83 | $398.11 |
- 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 / $389.05
| Professional | | $97.72 | $154.88 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $194.98 / $295.12
| Professional | | $112.20 | $194.98 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $154.88 / $288.40
| Professional | | $97.72 | $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
- $79.43 / $151.36 / $269.15
| Professional | | $79.43 | $151.36 | $269.15 |
- 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 / $218.78 / $281.84
| Professional | | $151.36 | $218.78 | $281.84 |
- 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
- $48.98 / $120.23 / $257.04
| Professional | | $48.98 | $120.23 | $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
- $95.50 / $154.88 / $316.23
| Professional | | $95.50 | $154.88 | $316.23 |