- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $93.76 / $93.76 / $93.76
| Facility | | $93.76 | $93.76 | $93.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.59 / $98.33 / $141.94
| Professional | | $87.59 | $98.33 | $141.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.02 / $119.36 / $216.84
| Professional | | $115.02 | $119.36 | $216.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $132.90 / $132.90 / $132.90
| Facility | | $132.90 | $132.90 | $132.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.51 / $141.85 / $223.96
| Professional | | $108.51 | $141.85 | $223.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $249.67 / $249.67 / $249.67
| Facility | | $249.67 | $249.67 | $249.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.26 / $171.06 / $304.48
| Professional | | $130.26 | $171.06 | $304.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.46 / $166.46 / $166.46
| Professional | | $166.46 | $166.46 | $166.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $93.76 / $93.76 / $93.76
| Facility | | $93.76 | $93.76 | $93.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.50 / $118.13 / $200.74
| Professional | | $90.50 | $118.13 | $200.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.80 / $227.70 / $291.80
| Professional | | $179.80 | $227.70 | $291.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $132.90 / $132.90 / $132.90
| Facility | | $132.90 | $132.90 | $132.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.51 / $141.05 / $223.96
| Professional | | $108.51 | $141.05 | $223.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.46 / $115.01 / $119.08
| Professional | | $111.46 | $115.01 | $119.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.90 / $131.87 / $224.50
| Professional | | $101.90 | $131.87 | $224.50 |