- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $145.46 / $145.46 / $145.46
| Facility | | $145.46 | $145.46 | $145.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.60 / $145.88 / $443.64
| Professional | | $115.60 | $145.88 | $443.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.37 / $684.76 / $684.76
| Facility | | $309.37 | $684.76 | $684.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.49 / $240.03 / $1,352.50
| Professional | | $153.49 | $240.03 | $1,352.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.26 / $261.83 / $354.73
| Professional | | $169.26 | $261.83 | $354.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.16 / $162.16 / $162.16
| Facility | | $162.16 | $162.16 | $162.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.47 / $218.85 / $386.88
| Professional | | $139.47 | $218.85 | $386.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.49 / $165.49 / $165.49
| Facility | | $165.49 | $165.49 | $165.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.43 / $148.49 / $255.13
| Professional | | $80.43 | $148.49 | $255.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.62 / $336.03 / $431.97
| Professional | | $171.62 | $336.03 | $431.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $240.98 / $240.98 / $240.98
| Facility | | $240.98 | $240.98 | $240.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.51 / $265.45 / $439.27
| Professional | | $187.51 | $265.45 | $439.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.37 / $684.76 / $684.76
| Facility | | $309.37 | $684.76 | $684.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.03 / $225.83 / $1,352.50
| Professional | | $155.03 | $225.83 | $1,352.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.62 / $209.74 / $375.37
| Professional | | $150.62 | $209.74 | $375.37 |