- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $95.17 / $116.87 / $441.32
| Facility | | $95.17 | $116.87 | $441.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.05 / $145.90 / $214.48
| Professional | | $98.05 | $145.90 | $214.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.95 / $157.62 / $206.28
| Professional | | $125.95 | $157.62 | $206.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.94 / $127.91 / $231.02
| Professional | | $92.94 | $127.91 | $231.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.12 / $193.64 / $195.14
| Professional | | $123.12 | $193.64 | $195.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $124.08 / $148.62 / $188.55
| Facility | | $124.08 | $148.62 | $188.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.11 / $195.14 / $306.02
| Professional | | $150.11 | $195.14 | $306.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $178.68 / $178.68 / $178.68
| Facility | | $178.68 | $178.68 | $178.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.55 / $184.08 / $298.05
| Professional | | $138.55 | $184.08 | $298.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $178.68 / $178.68 / $524.29
| Facility | | $178.68 | $178.68 | $524.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.69 / $196.74 / $307.18
| Professional | | $144.69 | $196.74 | $307.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.80 / $149.32 / $234.93
| Professional | | $90.80 | $149.32 | $234.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.00 / $204.34 / $295.11
| Professional | | $105.00 | $204.34 | $295.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.38 / $204.34 / $315.44
| Professional | | $148.38 | $204.34 | $315.44 |