- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.82 / $131.83 / $154.88
| Facility | | $114.82 | $131.83 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $104.71 / $245.47
| Professional | | $75.86 | $104.71 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $602.56
| Facility | | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $128.82 / $363.08
| Professional | | $85.11 | $128.82 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.89 / $162.18 / $269.15
| Facility | | $125.89 | $162.18 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $128.82 / $281.84
| Professional | | $93.33 | $128.82 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $93.33 / $208.93
| Professional | | $64.57 | $93.33 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $131.83
| Facility | | $100.00 | $100.00 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $112.20 / $204.17
| Professional | | $61.66 | $112.20 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $144.54 / $257.04
| Professional | | $89.13 | $144.54 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.20 / $91.20 / $120.23
| Facility | | $91.20 | $91.20 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $91.20 / $120.23
| Professional | | $91.20 | $91.20 | $120.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $602.56
| Facility | | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $128.82 / $354.81
| Professional | | $85.11 | $128.82 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $75.86 / $79.43
| Professional | | $69.18 | $75.86 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $239.88 / $239.88
| Facility | | $239.88 | $239.88 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $120.23 / $251.19
| Professional | | $85.11 | $120.23 | $251.19 |