- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.00 / $118.43 / $233.94
| Facility | | $60.00 | $118.43 | $233.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.00 / $60.00 / $131.04
| Professional | | $60.00 | $60.00 | $131.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.59 / $60.00 / $91.56
| Professional | | $50.59 | $60.00 | $91.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.93 / $54.93 / $57.68
| Facility | | $54.93 | $54.93 | $57.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.93 / $54.93 / $54.93
| Professional | | $54.93 | $54.93 | $54.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.61 / $56.61 / $60.00
| Facility | | $56.61 | $56.61 | $60.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.00 / $60.00 / $60.00
| Professional | | $60.00 | $60.00 | $60.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.61 / $84.92 / $332.00
| Facility | | $56.61 | $84.92 | $332.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.09 / $65.09 / $99.22
| Professional | | $65.09 | $65.09 | $99.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.00 / $60.00 / $62.27
| Facility | | $60.00 | $60.00 | $62.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.00 / $60.00 / $62.27
| Professional | | $60.00 | $60.00 | $62.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.61 / $56.61 / $555.00
| Facility | | $56.61 | $56.61 | $555.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.00 / $60.00 / $81.13
| Professional | | $11.00 | $60.00 | $81.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.00 / $60.00 / $100.83
| Professional | | $60.00 | $60.00 | $100.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $62.27 / $62.27 / $62.27
| Facility | | $62.27 | $62.27 | $62.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.63 / $60.00 / $62.27
| Professional | | $25.63 | $60.00 | $62.27 |