- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.67 / $137.78 / $1,615.00
| Facility | | $61.67 | $137.78 | $1,615.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.61 / $106.22 / $234.47
| Professional | | $58.61 | $106.22 | $234.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.15 / $105.05 / $245.66
| Professional | | $65.15 | $105.05 | $245.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.28 / $116.84 / $265.39
| Professional | | $72.28 | $116.84 | $265.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.67 / $134.43 / $190.65
| Facility | | $61.67 | $134.43 | $190.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.61 / $136.61 / $136.61
| Professional | | $136.61 | $136.61 | $136.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.53 / $106.20 / $209.62
| Professional | | $49.53 | $106.20 | $209.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $361.00 / $896.00 / $2,229.00
| Facility | | $361.00 | $896.00 | $2,229.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.79 / $137.33 / $311.72
| Professional | | $93.79 | $137.33 | $311.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $300.25 / $300.25
| Facility | | $55.00 | $300.25 | $300.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.88 / $984.08 / $1,138.95
| Professional | | $512.88 | $984.08 | $1,138.95 |