- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $115.32 / $115.32 / $115.32
| Facility | | $115.32 | $115.32 | $115.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.08 / $108.53 / $138.38
| Professional | | $94.08 | $108.53 | $138.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $215.55 / $593.79 / $593.79
| Facility | | $215.55 | $593.79 | $593.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.51 / $185.85 / $729.32
| Professional | | $124.51 | $185.85 | $729.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.66 / $138.66 / $138.66
| Facility | | $138.66 | $138.66 | $138.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.45 / $104.45 / $147.08
| Professional | | $104.45 | $104.45 | $147.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $115.30 / $115.30 / $146.94
| Facility | | $115.30 | $115.30 | $146.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.91 / $157.52 / $240.78
| Professional | | $124.91 | $157.52 | $240.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.77 / $285.01 / $364.89
| Professional | | $143.77 | $285.01 | $364.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $215.55 / $593.79 / $593.79
| Facility | | $215.55 | $593.79 | $593.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.51 / $185.85 / $729.32
| Professional | | $124.51 | $185.85 | $729.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.84 / $173.55 / $312.45
| Professional | | $121.84 | $173.55 | $312.45 |