- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.54 / $57.54 / $57.54
| Facility | | $57.54 | $57.54 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.74 / $52.48 / $85.11
| Professional | | $40.74 | $52.48 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.07 / $66.07 / $66.07
| Facility | | $66.07 | $66.07 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $48.98 / $48.98
| Professional | | $48.98 | $48.98 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $190.55 / $234.42
| Professional | | $72.44 | $190.55 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.54 / $72.44 / $100.00
| Facility | | $57.54 | $72.44 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $75.86 / $102.33
| Professional | | $70.79 | $75.86 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.86 / $93.33 / $100.00
| Facility | | $75.86 | $93.33 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $95.50 / $100.00
| Professional | | $87.10 | $95.50 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48.98 / $79.43 / $120.23
| Facility | | $48.98 | $79.43 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $83.18 / $100.00
| Professional | | $48.98 | $83.18 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.43 / $134.90 / $363.08
| Facility | | $79.43 | $134.90 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $107.15 / $107.15
| Professional | | $97.72 | $107.15 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43.65 / $144.54 / $190.55
| Facility | | $43.65 | $144.54 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $43.65 / $83.18
| Professional | | $39.81 | $43.65 | $83.18 |