- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.72 / $186.21 / $309.03
| Facility | | $97.72 | $186.21 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $100.00 / $199.53
| Professional | | $89.13 | $100.00 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.20 / $128.82 / $223.87
| Facility | | $112.20 | $128.82 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $77.62 / $177.83
| Professional | | $60.26 | $77.62 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $141.25 / $141.25
| Facility | | $141.25 | $141.25 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $165.96 / $165.96
| Professional | | $165.96 | $165.96 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.43 / $79.43 / $467.74
| Facility | | $79.43 | $79.43 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $112.20 / $263.03
| Professional | | $61.66 | $112.20 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81.28 / $125.89 / $501.19
| Facility | | $81.28 | $125.89 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $109.65 / $245.47
| Professional | | $61.66 | $109.65 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $109.65 / $151.36
| Professional | | $91.20 | $109.65 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.91 / $147.91 / $147.91
| Facility | | $147.91 | $147.91 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $151.36 / $281.84
| Professional | | $104.71 | $151.36 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43.65 / $109.65 / $123.03
| Facility | | $43.65 | $109.65 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $74.13 / $151.36
| Professional | | $51.29 | $74.13 | $151.36 |