- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $103.79 / $133.29 / $190.24
| Facility | | $103.79 | $133.29 | $190.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.11 / $120.09 / $165.72
| Professional | | $92.11 | $120.09 | $165.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $515.85 / $515.85 / $515.85
| Facility | | $515.85 | $515.85 | $515.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.27 / $218.62 / $817.07
| Professional | | $118.27 | $218.62 | $817.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $121.39 / $243.62 / $289.64
| Facility | | $121.39 | $243.62 | $289.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.03 / $202.92 / $287.95
| Professional | | $142.03 | $202.92 | $287.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $134.00 / $298.58
| Professional | | $100.00 | $134.00 | $298.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $122.11 / $149.63 / $181.90
| Facility | | $122.11 | $149.63 | $181.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.11 / $141.15 / $158.87
| Professional | | $122.11 | $141.15 | $158.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.58 / $240.57 / $346.20
| Professional | | $127.58 | $240.57 | $346.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $170.88 / $170.88 / $191.89
| Facility | | $170.88 | $170.88 | $191.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.95 / $282.70 / $1,048.05
| Professional | | $170.95 | $282.70 | $1,048.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $515.85 / $515.85 / $515.85
| Facility | | $515.85 | $515.85 | $515.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.63 / $218.51 / $817.07
| Professional | | $133.63 | $218.51 | $817.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.84 / $121.84 / $197.61
| Professional | | $121.84 | $121.84 | $197.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.53 / $167.79 / $367.75
| Professional | | $128.53 | $167.79 | $367.75 |