- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $133.13 / $182.09 / $200.00
| Facility | | $133.13 | $182.09 | $200.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.48 / $133.13 / $491.00
| Professional | | $82.48 | $133.13 | $491.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.89 / $161.47 / $490.42
| Professional | | $85.89 | $161.47 | $490.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $237.90 / $278.00 / $426.46
| Facility | | $237.90 | $278.00 | $426.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.71 / $310.01 / $352.29
| Professional | | $114.71 | $310.01 | $352.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $78.04 / $133.13 / $332.85
| Facility | | $78.04 | $133.13 | $332.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $78.04 / $133.13 / $583.00
| Facility | | $78.04 | $133.13 | $583.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.23 / $203.26 / $1,285.65
| Professional | | $100.23 | $203.26 | $1,285.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.84 / $65.00 / $188.51
| Professional | | $25.84 | $65.00 | $188.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $78.04 / $133.13 / $332.85
| Facility | | $78.04 | $133.13 | $332.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.63 / $246.57 / $649.80
| Professional | | $161.63 | $246.57 | $649.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $350.00 / $583.00 / $583.00
| Facility | | $350.00 | $583.00 | $583.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.57 / $445.75 / $1,285.65
| Professional | | $130.57 | $445.75 | $1,285.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.67 / $229.67 / $229.67
| Professional | | $229.67 | $229.67 | $229.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.82 / $552.44 / $552.44
| Professional | | $267.82 | $552.44 | $552.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.07 / $186.94 / $380.58
| Professional | | $100.07 | $186.94 | $380.58 |