- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $338.84 / $467.74
| Facility | | $104.71 | $338.84 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $120.23 / $141.25
| Professional | | $100.00 | $120.23 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $389.05 / $707.95
| Facility | | $158.49 | $389.05 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $151.36 / $436.52
| Professional | | $89.13 | $151.36 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $186.21 / $269.15
| Facility | | $151.36 | $186.21 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $128.82 / $128.82
| Professional | | $128.82 | $128.82 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.15 / $117.49 / $239.88
| Facility | | $107.15 | $117.49 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $165.96 / $199.53
| Professional | | $87.10 | $165.96 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $218.78 / $257.04
| Professional | | $218.78 | $218.78 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $151.36 / $239.88
| Professional | | $151.36 | $151.36 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $389.05 / $707.95
| Facility | | $158.49 | $389.05 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $151.36 / $436.52
| Professional | | $89.13 | $151.36 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $89.13 / $89.13 / $181.97
| Facility | | $89.13 | $89.13 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $120.23 / $263.03
| Professional | | $89.13 | $120.23 | $263.03 |