- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42.29 / $45.93 / $45.93
| Facility | | $42.29 | $45.93 | $45.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.29 / $46.40 / $58.27
| Professional | | $42.29 | $46.40 | $58.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.69 / $3,159.00 / $14,886.03
| Facility | | $2,344.69 | $3,159.00 | $14,886.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.60 / $66.93 / $93.67
| Professional | | $41.60 | $66.93 | $93.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.55 / $65.93 / $106.68
| Professional | | $47.55 | $65.93 | $106.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.27 / $71.67 / $72.09
| Professional | | $54.27 | $71.67 | $72.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,187.32 / $1,187.32 / $1,187.32
| Facility | | $1,187.32 | $1,187.32 | $1,187.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45.93 / $45.93 / $45.93
| Facility | | $45.93 | $45.93 | $45.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.29 / $47.06 / $83.44
| Professional | | $42.29 | $47.06 | $83.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.80 / $98.00 / $117.10
| Professional | | $80.80 | $98.00 | $117.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.88 / $68.58 / $109.15
| Professional | | $48.88 | $68.58 | $109.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44.22 / $44.22 / $44.22
| Facility | | $44.22 | $44.22 | $44.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.22 / $44.22 / $44.22
| Professional | | $44.22 | $44.22 | $44.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.00 / $577.00 / $3,742.00
| Facility | | $162.00 | $577.00 | $3,742.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.25 / $60.43 / $98.51
| Professional | | $47.25 | $60.43 | $98.51 |