- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $175.47 / $175.47 / $175.47
| Facility | | $175.47 | $175.47 | $175.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.71 / $182.10 / $238.68
| Professional | | $148.71 | $182.10 | $238.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $352.98 / $952.86 / $952.86
| Facility | | $352.98 | $952.86 | $952.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.77 / $313.20 / $1,182.54
| Professional | | $197.77 | $313.20 | $1,182.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $477.63 / $509.15 / $596.23
| Facility | | $477.63 | $509.15 | $596.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.81 / $339.81 / $467.93
| Professional | | $182.81 | $339.81 | $467.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $217.02 / $217.02 / $217.02
| Facility | | $217.02 | $217.02 | $217.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.84 / $167.84 / $238.13
| Professional | | $167.84 | $167.84 | $238.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $222.60 / $222.60 / $222.60
| Facility | | $222.60 | $222.60 | $222.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.98 / $264.70 / $412.16
| Professional | | $204.98 | $264.70 | $412.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.01 / $452.32 / $581.45
| Professional | | $231.01 | $452.32 | $581.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $352.98 / $952.86 / $952.86
| Facility | | $352.98 | $952.86 | $952.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.77 / $304.50 / $1,182.54
| Professional | | $197.77 | $304.50 | $1,182.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.08 / $281.30 / $537.75
| Professional | | $196.08 | $281.30 | $537.75 |