- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.86 / $89.13 / $117.49
| Facility | | $75.86 | $89.13 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $77.62 / $128.82
| Professional | | $60.26 | $77.62 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $436.52 / $436.52
| Facility | | $436.52 | $436.52 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $104.71 / $275.42
| Professional | | $72.44 | $104.71 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.86 / $100.00 / $239.88
| Facility | | $75.86 | $100.00 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $117.49 / $173.78
| Professional | | $75.86 | $117.49 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.88 / $83.18 / $154.88
| Professional | | $58.88 | $83.18 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $63.10 / $63.10 / $81.28
| Facility | | $63.10 | $63.10 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.67 / $85.11 / $154.88
| Professional | | $44.67 | $85.11 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $104.71 / $190.55
| Professional | | $67.61 | $104.71 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.03 / $138.04 / $275.42
| Facility | | $123.03 | $138.04 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $123.03 / $245.47
| Professional | | $123.03 | $123.03 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $436.52 / $436.52
| Facility | | $436.52 | $436.52 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $104.71 / $275.42
| Professional | | $72.44 | $104.71 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $102.33 / $199.53
| Professional | | $75.86 | $102.33 | $199.53 |