- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $150.38 / $150.38 / $150.38
| Facility | | $150.38 | $150.38 | $150.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.38 / $150.38 / $192.73
| Professional | | $111.38 | $150.38 | $192.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $268.56 / $301.75 / $547.86
| Facility | | $268.56 | $301.75 | $547.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.87 / $155.87 / $168.34
| Professional | | $155.87 | $155.87 | $168.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $159.91 / $159.91 / $159.91
| Facility | | $159.91 | $159.91 | $159.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.74 / $116.74 / $392.63
| Professional | | $116.74 | $116.74 | $392.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $82.43 / $150.38 / $337.86
| Facility | | $82.43 | $150.38 | $337.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.43 / $82.43 / $82.43
| Professional | | $82.43 | $82.43 | $82.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.05 / $335.70 / $531.75
| Professional | | $196.05 | $335.70 | $531.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.40 / $127.68 / $192.33
| Professional | | $115.40 | $127.68 | $192.33 |