- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $86.18 / $86.18 / $96.23
| Facility | | $86.18 | $86.18 | $96.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.59 / $94.10 / $131.77
| Professional | | $76.59 | $94.10 | $131.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $433.30 / $433.30 / $433.30
| Facility | | $433.30 | $433.30 | $433.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.48 / $144.16 / $562.37
| Professional | | $82.48 | $144.16 | $562.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.52 / $134.87 / $160.35
| Facility | | $100.52 | $134.87 | $160.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.62 / $140.55 / $220.28
| Professional | | $86.62 | $140.55 | $220.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.00 / $110.00 / $267.19
| Professional | | $70.00 | $110.00 | $267.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $111.35 / $111.35 / $117.00
| Facility | | $111.35 | $111.35 | $117.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.80 / $111.35 / $166.07
| Professional | | $65.80 | $111.35 | $166.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.00 / $195.67 / $278.01
| Professional | | $94.00 | $195.67 | $278.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.00 / $117.00 / $117.00
| Facility | | $117.00 | $117.00 | $117.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $494.19 / $637.97 / $696.49
| Professional | | $494.19 | $637.97 | $696.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $433.30 / $433.30 / $433.30
| Facility | | $433.30 | $433.30 | $433.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.48 / $128.30 / $617.49
| Professional | | $82.48 | $128.30 | $617.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.46 / $101.05 / $136.41
| Facility | | $61.46 | $101.05 | $136.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.68 / $109.97 / $265.95
| Professional | | $79.68 | $109.97 | $265.95 |