- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $92.03 / $94.17 / $104.71
| Facility | | $92.03 | $94.17 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.03 / $92.03 / $103.44
| Professional | | $92.03 | $92.03 | $103.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.95 / $87.79 / $163.04
| Professional | | $72.95 | $87.79 | $163.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.75 / $75.75 / $75.75
| Facility | | $75.75 | $75.75 | $75.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.75 / $75.75 / $75.75
| Professional | | $75.75 | $75.75 | $75.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.16 / $109.16 / $109.16
| Facility | | $109.16 | $109.16 | $109.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.90 / $86.90 / $86.90
| Professional | | $86.90 | $86.90 | $86.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $150.66 / $246.04 / $332.00
| Facility | | $150.66 | $246.04 | $332.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.01 / $133.41 / $198.14
| Professional | | $107.01 | $133.41 | $198.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.31 / $91.31 / $108.66
| Facility | | $91.31 | $91.31 | $108.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.59 / $106.83 / $223.66
| Professional | | $79.59 | $106.83 | $223.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.38 / $69.38 / $69.38
| Professional | | $69.38 | $69.38 | $69.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.16 / $109.16 / $195.27
| Facility | | $109.16 | $109.16 | $195.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.56 / $86.90 / $181.32
| Professional | | $67.56 | $86.90 | $181.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.45 / $98.07 / $199.06
| Professional | | $70.45 | $98.07 | $199.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.31 / $105.08 / $108.66
| Facility | | $91.31 | $105.08 | $108.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.16 / $106.83 / $224.90
| Professional | | $86.16 | $106.83 | $224.90 |