- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.65 / $150.54 / $153.44
| Facility | | $147.65 | $150.54 | $153.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.86 / $153.44 / $248.97
| Professional | | $141.86 | $153.44 | $248.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.86 / $196.86 / $196.86
| Professional | | $196.86 | $196.86 | $196.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $330.62 / $330.62 / $330.62
| Facility | | $330.62 | $330.62 | $330.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $180.71 / $180.71 / $180.71
| Facility | | $180.71 | $180.71 | $180.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.91 / $131.91 / $180.71
| Professional | | $131.91 | $131.91 | $180.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $917.07 / $1,641.93 / $1,831.60
| Facility | | $917.07 | $1,641.93 | $1,831.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,898.90 / $2,968.47 / $2,968.47
| Professional | | $2,898.90 | $2,968.47 | $2,968.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $93.15 / $230.41 / $330.62
| Facility | | $93.15 | $230.41 | $330.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.15 / $297.56 / $330.62
| Professional | | $93.15 | $297.56 | $330.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.62 / $363.68 / $743.89
| Professional | | $330.62 | $363.68 | $743.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $93.15 / $220.91 / $330.62
| Facility | | $93.15 | $220.91 | $330.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.91 / $131.91 / $192.64
| Professional | | $131.91 | $131.91 | $192.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $177.86 / $206.99
| Professional | | $120.23 | $177.86 | $206.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.61 / $173.26 / $330.62
| Professional | | $172.61 | $173.26 | $330.62 |