- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.50 / $237.49 / $308.52
| Facility | | $102.50 | $237.49 | $308.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.50 / $103.96 / $122.80
| Professional | | $102.50 | $103.96 | $122.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $94.92 / $111.67 / $8,639.91
| Facility | | $94.92 | $111.67 | $8,639.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.82 / $106.82 / $106.82
| Professional | | $106.82 | $106.82 | $106.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.11 / $102.94 / $102.94
| Facility | | $97.11 | $102.94 | $102.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.94 / $102.94 / $102.94
| Professional | | $102.94 | $102.94 | $102.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.50 / $237.49 / $308.52
| Facility | | $102.50 | $237.49 | $308.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.50 / $103.96 / $308.52
| Professional | | $102.50 | $103.96 | $308.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.11 / $102.94 / $102.94
| Facility | | $97.11 | $102.94 | $102.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.94 / $102.94 / $102.94
| Professional | | $102.94 | $102.94 | $102.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.93 / $102.93 / $102.93
| Facility | | $102.93 | $102.93 | $102.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.94 / $102.94 / $163.19
| Professional | | $102.94 | $102.94 | $163.19 |