- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.47 / $108.47 / $108.47
| Facility | | $108.47 | $108.47 | $108.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.64 / $112.81 / $131.25
| Professional | | $97.64 | $112.81 | $131.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.10 / $161.51 / $335.93
| Professional | | $117.10 | $161.51 | $335.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.23 / $498.08 / $764.07
| Facility | | $426.23 | $498.08 | $764.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.22 / $203.85 / $296.48
| Professional | | $145.22 | $203.85 | $296.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.47 / $129.84 / $200.13
| Facility | | $108.47 | $129.84 | $200.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.47 / $129.84 / $209.41
| Facility | | $108.47 | $129.84 | $209.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.94 / $250.94 / $920.30
| Professional | | $148.94 | $250.94 | $920.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.91 / $113.00 / $265.86
| Professional | | $77.91 | $113.00 | $265.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.47 / $129.84 / $200.13
| Facility | | $108.47 | $129.84 | $200.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.06 / $239.06 / $652.90
| Facility | | $239.06 | $239.06 | $652.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.22 / $688.41 / $920.30
| Professional | | $145.22 | $688.41 | $920.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.62 / $150.62 / $150.62
| Professional | | $150.62 | $150.62 | $150.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.24 / $259.24 / $331.78
| Professional | | $259.24 | $259.24 | $331.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.71 / $230.19 / $346.96
| Professional | | $143.71 | $230.19 | $346.96 |