- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.77 / $303.22 / $393.92
| Facility | | $130.77 | $303.22 | $393.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.47 / $130.77 / $320.70
| Professional | | $129.47 | $130.77 | $320.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $119.40 / $140.47 / $8,639.91
| Facility | | $119.40 | $140.47 | $8,639.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.37 / $134.37 / $140.47
| Professional | | $134.37 | $134.37 | $140.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $122.15 / $129.47 / $129.47
| Facility | | $122.15 | $129.47 | $129.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.47 / $129.47 / $129.47
| Professional | | $129.47 | $129.47 | $129.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $361.81 / $361.81 / $361.81
| Facility | | $361.81 | $361.81 | $361.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.87 / $303.22 / $393.92
| Facility | | $130.87 | $303.22 | $393.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.47 / $141.65 / $393.92
| Professional | | $129.47 | $141.65 | $393.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $122.15 / $129.47 / $129.47
| Facility | | $122.15 | $129.47 | $129.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.47 / $129.47 / $129.47
| Professional | | $129.47 | $129.47 | $129.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.13 / $125.13 / $145.19
| Facility | | $125.13 | $125.13 | $145.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.13 / $125.13 / $145.19
| Professional | | $125.13 | $125.13 | $145.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.47 / $129.47 / $168.97
| Professional | | $129.47 | $129.47 | $168.97 |