- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $89.13 / $102.33 / $512.86
| Facility | | $89.13 | $102.33 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $147.91 / $316.23
| Professional | | $77.62 | $147.91 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $67.61 / $109.65 / $524.81
| Facility | | $67.61 | $109.65 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $131.83 / $331.13
| Professional | | $81.28 | $131.83 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $162.18 / $251.19
| Professional | | $95.50 | $162.18 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $131.83 / $245.47
| Professional | | $83.18 | $131.83 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $74.13 / $75.86 / $95.50
| Facility | | $74.13 | $75.86 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $158.49 / $229.09
| Professional | | $131.83 | $158.49 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $158.49 / $288.40
| Professional | | $87.10 | $158.49 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $177.83 / $239.88
| Professional | | $117.49 | $177.83 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $67.61 / $109.65 / $524.81
| Facility | | $67.61 | $109.65 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $131.83 / $338.84
| Professional | | $81.28 | $131.83 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $67.61 / $77.62
| Facility | | $56.23 | $67.61 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $100.00 / $218.78
| Professional | | $67.61 | $100.00 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $85.11 / $85.11 / $85.11
| Facility | | $85.11 | $85.11 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $131.83 / $269.15
| Professional | | $77.62 | $131.83 | $269.15 |