- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.72 / $120.72 / $256.52
| Facility | | $120.72 | $120.72 | $256.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.72 / $120.72 / $120.72
| Professional | | $120.72 | $120.72 | $120.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $116.82 / $161.16 / $556.42
| Facility | | $116.82 | $161.16 | $556.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.29 / $48.29 / $78.45
| Professional | | $48.29 | $48.29 | $78.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.50 / $257.50 / $257.50
| Facility | | $257.50 | $257.50 | $257.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.47 / $72.48 / $157.50
| Professional | | $63.47 | $72.48 | $157.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.72 / $139.66 / $214.27
| Professional | | $120.72 | $139.66 | $214.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.72 / $120.72 / $195.57
| Facility | | $120.72 | $120.72 | $195.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.72 / $120.72 / $120.72
| Professional | | $120.72 | $120.72 | $120.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.53 / $72.43 / $126.96
| Professional | | $43.53 | $72.43 | $126.96 |