- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $116.96 / $164.03 / $526.32
| Facility | | $116.96 | $164.03 | $526.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.55 / $116.96 / $121.24
| Professional | | $105.55 | $116.96 | $121.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.68 / $127.65 / $427.89
| Facility | | $112.68 | $127.65 | $427.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.13 / $19.88 / $26.83
| Professional | | $17.13 | $19.88 | $26.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $142.63 / $185.42 / $228.21
| Facility | | $142.63 | $185.42 | $228.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.63 / $171.16 / $213.95
| Professional | | $142.63 | $171.16 | $213.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $92.71 / $142.63 / $318.20
| Facility | | $92.71 | $142.63 | $318.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.24 / $173.80 / $208.23
| Professional | | $26.24 | $173.80 | $208.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $142.63 / $142.63 / $142.63
| Facility | | $142.63 | $142.63 | $142.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.90 / $85.58 / $156.75
| Professional | | $59.90 | $85.58 | $156.75 |