- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.28 / $120.28 / $120.28
| Facility | | $120.28 | $120.28 | $120.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.26 / $132.81 / $317.75
| Professional | | $113.26 | $132.81 | $317.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.16 / $160.47 / $244.61
| Professional | | $130.16 | $160.47 | $244.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $149.41 / $149.41 / $149.41
| Facility | | $149.41 | $149.41 | $149.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.76 / $115.76 / $115.76
| Professional | | $115.76 | $115.76 | $115.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $284.05 / $284.05 / $284.05
| Facility | | $284.05 | $284.05 | $284.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.76 / $195.87 / $355.86
| Professional | | $148.76 | $195.87 | $355.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.63 / $130.41 / $157.76
| Professional | | $117.63 | $130.41 | $157.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.28 / $120.28 / $120.28
| Facility | | $120.28 | $120.28 | $120.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.75 / $156.36 / $338.91
| Professional | | $117.75 | $156.36 | $338.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.10 / $170.00 / $330.40
| Professional | | $144.10 | $170.00 | $330.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $149.41 / $149.41 / $149.41
| Facility | | $149.41 | $149.41 | $149.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.76 / $115.76 / $115.76
| Professional | | $115.76 | $115.76 | $115.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.10 / $127.90 / $132.88
| Professional | | $124.10 | $127.90 | $132.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.67 / $150.90 / $258.77
| Professional | | $120.67 | $150.90 | $258.77 |