- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $116.09 / $131.58 / $202.00
| Facility | | $116.09 | $131.58 | $202.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.39 / $94.88 / $150.15
| Professional | | $73.39 | $94.88 | $150.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $491.63 / $491.63 / $491.63
| Facility | | $491.63 | $491.63 | $491.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.11 / $143.33 / $636.03
| Professional | | $88.11 | $143.33 | $636.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.56 / $158.69 / $268.82
| Facility | | $125.56 | $158.69 | $268.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.59 / $167.62 / $272.07
| Professional | | $103.59 | $167.62 | $272.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.00 / $98.59 / $256.94
| Professional | | $67.00 | $98.59 | $256.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $101.43 / $111.57 / $124.37
| Facility | | $101.43 | $111.57 | $124.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.43 / $101.43 / $114.75
| Professional | | $101.43 | $101.43 | $114.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.36 / $200.72 / $299.97
| Professional | | $95.36 | $200.72 | $299.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.34 / $91.34 / $120.78
| Facility | | $91.34 | $91.34 | $120.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.34 / $91.34 / $157.43
| Professional | | $91.34 | $91.34 | $157.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $491.63 / $491.63 / $491.63
| Facility | | $491.63 | $491.63 | $491.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.21 / $131.51 / $636.03
| Professional | | $88.21 | $131.51 | $636.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.77 / $75.00 / $83.64
| Professional | | $61.77 | $75.00 | $83.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.05 / $114.97 / $231.70
| Professional | | $84.05 | $114.97 | $231.70 |