- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $144.54 / $144.54
| Facility | | $144.54 | $144.54 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $239.88 / $562.34
| Professional | | $114.82 | $239.88 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $891.25 / $891.25
| Facility | | $891.25 | $891.25 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $208.93 / $1,348.96
| Professional | | $138.04 | $208.93 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $269.15 / $363.08
| Professional | | $158.49 | $269.15 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $190.55 / $323.59
| Professional | | $131.83 | $190.55 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.89 / $125.89 / $151.36
| Facility | | $125.89 | $125.89 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $131.83 / $239.88
| Professional | | $72.44 | $131.83 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $234.42 / $346.74
| Professional | | $131.83 | $234.42 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $239.88 / $239.88
| Facility | | $239.88 | $239.88 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $288.40 / $288.40
| Professional | | $288.40 | $288.40 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $891.25 / $891.25
| Facility | | $891.25 | $891.25 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $208.93 / $1,348.96
| Professional | | $141.25 | $208.93 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $891.25 / $933.25
| Facility | | $891.25 | $891.25 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $199.53 / $338.84
| Professional | | $134.90 | $199.53 | $338.84 |