- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $87.10 / $245.47 / $575.44
| Facility | | $87.10 | $245.47 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $87.10 / $288.40
| Professional | | $60.26 | $87.10 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $128.82 / $323.59
| Facility | | $83.18 | $128.82 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.95 / $93.33 / $302.00
| Professional | | $54.95 | $93.33 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $223.87 / $323.59
| Facility | | $177.83 | $223.87 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $117.49 / $117.49
| Professional | | $89.13 | $117.49 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $70.79 / $125.89 / $194.98
| Facility | | $70.79 | $125.89 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.95 / $91.20 / $239.88
| Professional | | $54.95 | $91.20 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $131.83 / $154.88
| Professional | | $131.83 | $131.83 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $91.20 / $194.98
| Professional | | $91.20 | $91.20 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.72 / $120.23 / $257.04
| Facility | | $97.72 | $120.23 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $128.82 / $323.59
| Facility | | $83.18 | $128.82 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.95 / $93.33 / $346.74
| Professional | | $54.95 | $93.33 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.86 / $91.20 / $151.36
| Facility | | $75.86 | $91.20 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.95 / $91.20 / $190.55
| Professional | | $54.95 | $91.20 | $190.55 |