- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.02 / $100.02 / $100.02
| Facility | | $100.02 | $100.02 | $100.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.02 / $100.02 / $129.88
| Professional | | $100.02 | $100.02 | $129.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.84 / $151.63 / $153.16
| Professional | | $137.84 | $151.63 | $153.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $132.63 / $172.54 / $172.54
| Facility | | $132.63 | $172.54 | $172.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.63 / $172.54 / $270.94
| Professional | | $132.63 | $172.54 | $270.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $93.68 / $171.68 / $797.99
| Facility | | $93.68 | $171.68 | $797.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.24 / $78.25 / $130.41
| Professional | | $58.24 | $78.25 | $130.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $172.03 / $172.54 / $230.17
| Facility | | $172.03 | $172.54 | $230.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.22 / $206.78 / $355.47
| Professional | | $156.22 | $206.78 | $355.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.73 / $78.25 / $113.74
| Professional | | $56.73 | $78.25 | $113.74 |