- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.47 / $80.45 / $115.14
| Facility | | $52.47 | $80.45 | $115.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.47 / $52.56 / $62.97
| Professional | | $52.47 | $52.56 | $62.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.61 / $101.12 / $193.71
| Facility | | $40.61 | $101.12 | $193.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.87 / $51.87 / $51.87
| Professional | | $51.87 | $51.87 | $51.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $53.11 / $53.11 / $80.00
| Facility | | $53.11 | $53.11 | $80.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $49.50 / $52.47 / $52.47
| Facility | | $49.50 | $52.47 | $52.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.47 / $52.47 / $52.47
| Professional | | $52.47 | $52.47 | $52.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.00 / $254.60 / $262.35
| Facility | | $75.00 | $254.60 | $262.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,790.38 / $1,790.38 / $1,790.38
| Professional | | $1,790.38 | $1,790.38 | $1,790.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.04 / $52.47 / $83.51
| Facility | | $52.04 | $52.47 | $83.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.47 / $53.52 / $86.58
| Professional | | $52.47 | $53.52 | $86.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.21 / $58.42 / $97.70
| Professional | | $52.21 | $58.42 | $97.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.47 / $52.47 / $85.48
| Facility | | $52.47 | $52.47 | $85.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.47 / $52.47 / $62.61
| Professional | | $52.47 | $52.47 | $62.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.47 / $55.62 / $58.41
| Professional | | $52.47 | $55.62 | $58.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.28 / $52.47 / $73.45
| Professional | | $50.28 | $52.47 | $73.45 |