- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.40 / $202.13 / $283.89
| Professional | | $132.40 | $202.13 | $283.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.83 / $237.83 / $237.83
| Professional | | $237.83 | $237.83 | $237.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.85 / $290.06 / $378.53
| Professional | | $37.85 | $290.06 | $378.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.45 / $263.45 / $325.44
| Facility | | $263.45 | $263.45 | $325.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.93 / $223.93 / $548.44
| Professional | | $223.93 | $223.93 | $548.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $348.25 / $348.25 / $378.53
| Professional | | $348.25 | $348.25 | $378.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.83 / $256.88 / $299.38
| Professional | | $237.83 | $256.88 | $299.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.35 / $266.13 / $401.08
| Professional | | $170.35 | $266.13 | $401.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.45 / $263.45 / $325.44
| Facility | | $263.45 | $263.45 | $325.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.93 / $297.51 / $548.44
| Professional | | $223.93 | $297.51 | $548.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.39 / $362.58 / $362.58
| Professional | | $285.39 | $362.58 | $362.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.77 / $208.11 / $365.07
| Professional | | $147.77 | $208.11 | $365.07 |