- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.66 / $70.33 / $74.72
| Facility | | $60.66 | $70.33 | $74.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.66 / $72.97 / $74.72
| Professional | | $60.66 | $72.97 | $74.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $0.03 / $73.00
| Professional | | $0.02 | $0.03 | $73.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $243.50 / $243.50 / $243.50
| Facility | | $243.50 | $243.50 | $243.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.50 / $243.50 / $243.50
| Professional | | $243.50 | $243.50 | $243.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $136.94 / $160.47 / $247.92
| Facility | | $136.94 | $160.47 | $247.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.94 / $136.94 / $136.94
| Professional | | $136.94 | $136.94 | $136.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.32 / $102.32 / $102.32
| Facility | | $102.32 | $102.32 | $102.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.72 / $88.97 / $88.97
| Professional | | $74.72 | $88.97 | $88.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.72 / $74.72 / $74.72
| Professional | | $74.72 | $74.72 | $74.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $136.94 / $160.47 / $597.00
| Facility | | $136.94 | $160.47 | $597.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.94 / $136.94 / $136.94
| Professional | | $136.94 | $136.94 | $136.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.51 / $83.51 / $112.73
| Professional | | $83.51 | $83.51 | $112.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $74.72 / $74.72 / $74.72
| Facility | | $74.72 | $74.72 | $74.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.72 / $74.72 / $74.72
| Professional | | $74.72 | $74.72 | $74.72 |