- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.29 / $183.16 / $960.18
| Professional | | $112.29 | $183.16 | $960.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $185.61 / $185.61 / $185.61
| Facility | | $185.61 | $185.61 | $185.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.50 / $135.50 / $185.61
| Professional | | $135.50 | $135.50 | $185.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.74 / $528.40 / $689.18
| Professional | | $213.74 | $528.40 | $689.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $183.16 / $250.93 / $305.33
| Facility | | $183.16 | $250.93 | $305.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.03 / $287.02 / $320.61
| Professional | | $227.03 | $287.02 | $320.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $242.36 / $274.81 / $305.33
| Facility | | $242.36 | $274.81 | $305.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.23 / $305.33 / $305.33
| Professional | | $260.23 | $305.33 | $305.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $172.50 / $260.27 / $320.61
| Facility | | $172.50 | $260.27 | $320.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.50 / $267.36 / $335.87
| Professional | | $135.50 | $267.36 | $335.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $254.39 / $507.76 / $1,071.20
| Facility | | $254.39 | $507.76 | $1,071.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.58 / $335.87 / $335.87
| Professional | | $262.58 | $335.87 | $335.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $195.26 / $195.26 / $195.26
| Facility | | $195.26 | $195.26 | $195.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.49 / $124.52 / $237.56
| Professional | | $118.49 | $124.52 | $237.56 |