- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.20 / $112.20 / $112.20
| Facility | | $112.20 | $112.20 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $104.71 / $169.82
| Professional | | $81.28 | $104.71 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $128.82 / $128.82
| Facility | | $128.82 | $128.82 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $95.50 / $95.50
| Professional | | $95.50 | $95.50 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $380.19 / $467.74
| Professional | | $144.54 | $380.19 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.82 / $144.54 / $199.53
| Facility | | $114.82 | $144.54 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $151.36 / $204.17
| Professional | | $141.25 | $151.36 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $186.21 / $194.98
| Facility | | $151.36 | $186.21 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $190.55 / $194.98
| Professional | | $190.55 | $190.55 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.72 / $154.88 / $239.88
| Facility | | $97.72 | $154.88 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $165.96 / $199.53
| Professional | | $87.10 | $165.96 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $269.15 / $724.44
| Facility | | $158.49 | $269.15 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $213.80 / $213.80
| Professional | | $194.98 | $213.80 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $85.11 / $281.84 / $380.19
| Facility | | $85.11 | $281.84 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $87.10 / $165.96
| Professional | | $77.62 | $87.10 | $165.96 |