- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.20 / $257.04 / $478.63
| Facility | | $91.20 | $257.04 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $100.00 / $144.54
| Professional | | $81.28 | $100.00 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.03 / $123.03 / $489.78
| Facility | | $123.03 | $123.03 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $60.26 / $107.15
| Professional | | $60.26 | $60.26 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $112.20 / $123.03
| Professional | | $107.15 | $112.20 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.89 / $302.00 / $630.96
| Facility | | $125.89 | $302.00 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $85.11 / $213.80
| Professional | | $61.66 | $85.11 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $134.90 / $169.82
| Professional | | $123.03 | $134.90 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.72 / $147.91 / $229.09
| Facility | | $97.72 | $147.91 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $97.72 / $257.04
| Professional | | $97.72 | $97.72 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.65 / $158.49 / $10,000.00
| Facility | | $109.65 | $158.49 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $162.18 / $10,000.00
| Professional | | $112.20 | $162.18 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.20 / $123.03 / $147.91
| Facility | | $91.20 | $123.03 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $67.61 / $165.96
| Professional | | $51.29 | $67.61 | $165.96 |