- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.65 / $136.72 / $266.00
| Facility | | $120.65 | $136.72 | $266.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $97.64 / $150.15
| Professional | | $75.86 | $97.64 | $150.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.91 / $512.91 / $512.91
| Facility | | $512.91 | $512.91 | $512.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.89 / $148.43 / $663.21
| Professional | | $91.89 | $148.43 | $663.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.96 / $165.54 / $268.82
| Facility | | $130.96 | $165.54 | $268.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.62 / $155.97 / $267.02
| Professional | | $107.62 | $155.97 | $267.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.00 / $107.00 / $267.89
| Professional | | $70.00 | $107.00 | $267.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $101.43 / $115.19 / $129.38
| Facility | | $101.43 | $115.19 | $129.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.76 / $101.43 / $119.68
| Professional | | $89.76 | $101.43 | $119.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.85 / $209.27 / $312.82
| Professional | | $102.85 | $209.27 | $312.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.67 / $92.70 / $233.11
| Facility | | $91.67 | $92.70 | $233.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.67 / $92.70 / $152.86
| Professional | | $91.67 | $92.70 | $152.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.91 / $512.91 / $512.91
| Facility | | $512.91 | $512.91 | $512.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.85 / $137.55 / $663.21
| Professional | | $92.85 | $137.55 | $663.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.15 / $97.18 / $186.80
| Professional | | $76.15 | $97.18 | $186.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.00 / $122.36 / $254.04
| Professional | | $90.00 | $122.36 | $254.04 |