- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $272.36 / $274.49 / $338.00
| Facility | | $272.36 | $274.49 | $338.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.20 / $272.07 / $308.39
| Professional | | $255.20 | $272.07 | $308.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.57 / $260.57 / $289.52
| Professional | | $260.57 | $260.57 | $289.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.56 / $54.78 / $54.78
| Professional | | $46.56 | $54.78 | $54.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.72 / $10.72 / $10.72
| Facility | | $10.72 | $10.72 | $10.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.70 / $22.70 / $22.70
| Professional | | $22.70 | $22.70 | $22.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $256.11 / $276.64 / $333.10
| Facility | | $256.11 | $276.64 | $333.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.42 / $140.57 / $258.47
| Professional | | $126.42 | $140.57 | $258.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $256.23 / $276.69 / $333.46
| Facility | | $256.23 | $276.69 | $333.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.70 / $22.70 / $22.70
| Professional | | $22.70 | $22.70 | $22.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.47 / $258.47 / $258.47
| Professional | | $258.47 | $258.47 | $258.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.91 / $295.87 / $403.10
| Professional | | $252.91 | $295.87 | $403.10 |