- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $125.89 / $275.42
| Facility | | $100.00 | $125.89 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $169.82 / $407.38
| Professional | | $89.13 | $169.82 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.86 / $117.49 / $588.84
| Facility | | $75.86 | $117.49 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $144.54 / $363.08
| Professional | | $91.20 | $144.54 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $181.97 / $275.42
| Professional | | $107.15 | $181.97 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $144.54 / $269.15
| Professional | | $93.33 | $144.54 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81.28 / $83.18 / $107.15
| Facility | | $81.28 | $83.18 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $169.82 / $245.47
| Professional | | $144.54 | $169.82 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $177.83 / $316.23
| Professional | | $97.72 | $177.83 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $398.11 / $407.38
| Facility | | $398.11 | $398.11 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $199.53 / $398.11
| Professional | | $128.82 | $199.53 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.86 / $117.49 / $588.84
| Facility | | $75.86 | $117.49 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $144.54 / $363.08
| Professional | | $91.20 | $144.54 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $63.10 / $75.86 / $93.33
| Facility | | $63.10 | $75.86 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $112.20 / $239.88
| Professional | | $72.44 | $112.20 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $95.50 / $95.50 / $95.50
| Facility | | $95.50 | $95.50 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $144.54 / $295.12
| Professional | | $89.13 | $144.54 | $295.12 |