- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.22 / $147.49 / $200.00
| Facility | | $104.22 | $147.49 | $200.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.43 / $104.22 / $420.31
| Professional | | $60.43 | $104.22 | $420.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.23 / $104.22 / $381.24
| Professional | | $67.23 | $104.22 | $381.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $191.94 / $218.11 / $344.07
| Facility | | $191.94 | $218.11 | $344.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.61 / $245.91 / $279.44
| Professional | | $101.61 | $245.91 | $279.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.43 / $83.81 / $134.97
| Facility | | $60.43 | $83.81 | $134.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.43 / $83.90 / $1,027.46
| Facility | | $60.43 | $83.90 | $1,027.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.88 / $168.59 / $462.17
| Professional | | $76.88 | $168.59 | $462.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.48 / $63.07 / $138.97
| Professional | | $37.48 | $63.07 | $138.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.43 / $83.81 / $139.18
| Facility | | $60.43 | $83.81 | $139.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.10 / $208.39 / $297.35
| Professional | | $139.10 | $208.39 | $297.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,229.45 / $1,229.45 / $1,229.45
| Facility | | $1,229.45 | $1,229.45 | $1,229.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.57 / $346.95 / $462.17
| Professional | | $103.57 | $346.95 | $462.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.57 / $181.57 / $181.57
| Professional | | $181.57 | $181.57 | $181.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.99 / $438.18 / $438.18
| Professional | | $222.99 | $438.18 | $438.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $590.33 / $590.33 / $590.33
| Facility | | $590.33 | $590.33 | $590.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.84 / $153.97 / $304.10
| Professional | | $75.84 | $153.97 | $304.10 |