- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $84.25 / $117.39 / $174.11
| Facility | | $84.25 | $117.39 | $174.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.67 / $105.48 / $267.00
| Professional | | $66.67 | $105.48 | $267.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $72.38 / $382.33 / $382.33
| Facility | | $72.38 | $382.33 | $382.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.48 / $202.61 / $715.23
| Professional | | $100.48 | $202.61 | $715.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.79 / $173.54 / $244.50
| Professional | | $115.79 | $173.54 | $244.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.52 / $104.52 / $104.52
| Facility | | $104.52 | $104.52 | $104.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.90 / $149.53 / $251.11
| Professional | | $86.90 | $149.53 | $251.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $78.37 / $78.37 / $99.88
| Facility | | $78.37 | $78.37 | $99.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.78 / $168.48 / $198.21
| Professional | | $146.78 | $168.48 | $198.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.76 / $211.89 / $312.81
| Professional | | $119.76 | $211.89 | $312.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.28 / $188.74 / $349.30
| Professional | | $163.28 | $188.74 | $349.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $382.33 / $382.33 / $382.33
| Facility | | $382.33 | $382.33 | $382.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.37 / $233.00 / $715.23
| Professional | | $118.37 | $233.00 | $715.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.92 / $65.92 / $95.82
| Facility | | $55.92 | $65.92 | $95.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.76 / $124.08 / $227.18
| Professional | | $96.76 | $124.08 | $227.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.77 / $162.16 / $292.12
| Professional | | $105.77 | $162.16 | $292.12 |